Herbal Hepatotoxicity: Acute Hepatitis caused by a Noni-preparation (Morinda citrifolia)

A 45 year old patient presented in our clinic with highly elevated transaminases (GOT 604, GPT 1.995 (normal range below 50 IU/ml) and GGT 539 (below 66 IU/ml) and elevated LDH (419, normal range below 232). The work-up revealed no sign for viral hepatitis including EBV and CMV, autoimmune hepatitis, Budd-Chiari-Syndrome, hemochromatosis or Wilson's disease. The patients had an otherwise unremarkable history and took no medication on regular basis. During the interview he admitted that for „prophylactic reasons“ he had been drinking a juice of Noni during the last three weeks, recommended by a friend. We suspect…