Acute liver injury following turmeric use in Tuscany: An analysis of the Italian Phytovigilance database and systematic review of case reports

Aims Several cases of acute non-infectious cholestatic hepatitis recently appeared in Italy following consumption ofCurcuma longa-containing dietary supplements. The aim of this research was to describe the Tuscan (Italy) cases of acute hepatitis and to compare them with similar cases of hepatotoxicity published in the literature by performing a systematic review. Methods Records of Tuscan cases of acute hepatitis were obtained from the Italian Phytovigilance system. Each spontaneous report was analysed in order to collect all relevant clinical information of patients and information concerning theCurcuma longa-containing dietary supplement. Moreover, both the RUCAM and WHO-UMC systems were used to evaluate the causal relationship between the use of dietary supplement and acute hepatitis. A systematic literature review was performed in MEDLINE and Embase and all case-reports and case-series published in English were included. Results Seven cases of acute hepatitis occurring in Tuscany up to September 2019 are described. In all cases, hepatotoxicity was associated withCurcuma longaformulations with high bioavailability and high dosage of curcumin/curcuminoids. The causal relationship was also supported by thepositive dechallengeobserved in most cases. In the 23 cases identified through the systematic review, the majority of patients were concomitantly exposed to at least one other medication and 16 of them experienced apositive dechallenge. Conclusions Within the frame of poorly controlled and regulated products, such as dietary supplements, the evaluation of Italian cases ofCurcuma longa-induced acute hepatitis and the systematic review of literature confirmed the association betweenCurcuma longaand liver injury.

Automated summary

Several cases of acute non-infectious cholestatic hepatitis in Italy were linked to the consumption of Curcuma longa-containing dietary supplements. Analysis of Tuscan cases revealed a strong association between hepatotoxicity and Curcuma longa formulations with high bioavailability and dosage. A systematic review of the literature further confirmed this association, with the majority of patients having positive dechallenge outcomes.