key: cord-0802128-azxnlxrx
authors: Gupta, Himanshu; Nigam, Neha; Singh, Surender; Roy, Akash; Dhiman, Radha K.
title: Immune boosting gone wrong? A COVID-Concoction-Conundrum
date: 2021-10-02
journal: J Clin Exp Hepatol
DOI: 10.1016/j.jceh.2021.09.022
sha: 921da890ef7ad710173e9ee595a70bac48545204
doc_id: 802128
cord_uid: azxnlxrx

nan

Letter to the editor,

We read with interest the case series by Nagral A et al. 1 . The authors highlight a vexing predicament brought to the fore amidst the frequent usage of "immune boosters" during the COVID-19 pandemic. In this context, we share our experience and delve into certain key issues. Immunostimulatory herbal supplements such as TC are known to exacerbate preexisting autoimmune disease or precipitate autoimmune disease in genetically predisposed individuals. 3 Multiple mechanisms have been proposed for the same, although exact pathways need further elaboration. 3 Causalty assessments scores in the cases reported by Nagral et al. 1 and ours do implicate TC as an offending agent. However, certain inherent limitations of causalty assessment, especially in AI-DILI remain debatable. To add to the challenge, unless there is presence of extensive background fibrosis, there are no absolute differentiating points on histopathology. 4 In this context, we re-enforce the need for a detailed mechanistic, toxicological and botanical analysis of such cases in conjunction with public awareness about the potential association. 

Herbal Immune Booster-Induced Liver Injury in the COVID-19 Pandemic -A Case Series

Herbal and dietary supplement-induced liver injury

Activation of autoimmunity following use of immunostimulatory herbal supplements

Liver fibrosis helps to distinguish autoimmune hepatitis from DILI with autoimmune features: a review of twenty cases