Hepatitis induced by noni juice from Morinda citrifolia: A rare cause of hepatotoxicity or the tip of the iceberg?

A 24-year-old female patient presented to her community hospital
with mild elevations of serum transaminase and bilirubin levels.
Because of multiple sclerosis, she was treated with interferon
beta-la for 6 weeks. After exclusion of viral hepatitis due to
hepatitis A-E, interferon beta-la was withdrawn under the suspicion
of drug-induced hepatitis. One week later, she was admitted again
to her community hospital with severe icterus. The transaminase and
bilirubin levels were highly elevated, and a beginning impairment
of the liver synthesis was expressed by a reduced prothrombin time.
The confinement to our department occurred with a fulminant
hepatitis and the suspicion of beginning acute liver failure. There
was no evidence for hepatitis due to potentially hepatotoxic
viruses, alcoholic hepatitis, Budd-Chiari syndrome,
hemochromatosis, and Wilson's disease. In her serum there were high
titers of liver-kidney microsomal type 1 autoantibody; the serum
gamma globulin levels were in the normal range. Fine-needle
aspiration biopsy of the liver ruled out an autoimmune hepatitis
but showed signs of drug-induced toxicity. During the interview,
she admitted that for `general immune system stimulation' she had
been drinking Noni juice, a Polynesian herbal remedy made from a
tropical fruit (Morinda citrifolia), during the past 4 weeks. After
cessation of the Noni juice ingestion, her transaminase levels
normalized quickly and were in the normal range within 1 month.
Copyright (c) 2006 S. Karger AG, Basel.