A complex case of severe acute hepatitis with cholestasis in a genetically predisposed woman: Could curcumin be the trigger?

Drug-Induced Liver Injury (DILI) can present as cholestatic hepati- tis and differential diagnosis with other etiologies is often challenging. The established trend of growth in consumption of Herbal Dietary Sup- plements (HDS) by the general population underlines the necessity of timely suspicion and early recognition of its complications. In this con- text, turmeric-derived substances, such as curcumin, are among the most consumed. Some case reports have already described incidents of DILI induced by these substances. Moreover, genetic variants in genes encoding for the canalicular hepatobiliary transporters, mainly the phospholipid flippase MDR3 (encode by the ABCB4 gene) and the canalicular bile salt export pump BSEP (encoded by the ABCC11 gene), have been involved in the pathogenesis of DILI. We report the case of a woman, genetically predisposed to cholestatic events, who experi- enced a severe incident of acute cholestatic hepatitis, at least partially imputable to the consumption of multiple HDS, including turmeric- derived compounds.