Turmeric supplement and recurrent liver injury in one woman
What it found
A 65-year-old woman developed severe liver injury two weeks after restarting a turmeric supplement with black pepper extract, having had a similar episode six years earlier.
Her liver enzymes improved with steroid treatment over three weeks.
What they found
Studies in people
Severe liver injury
The woman's liver enzymes were very high (AST 4310 U/L, ALT over 2500 U/L) and her bilirubin was 18.3 mg/dL. This was worse than her earlier episode six years before, when bilirubin peaked at 7.3 mg/dL.
Autoimmune features
Tests showed positive smooth muscle antibodies and elevated IgG, and a liver biopsy found acute hepatitis with plasma cells and cholestasis. These features overlap with autoimmune hepatitis.
Recurrence on re-exposure
Her liver injury came back after she restarted the same supplement, and it was more severe than the first time. The authors say this suggests immune sensitization.
Steroid response
Her liver enzymes improved over three weeks after she was given intravenous methylprednisolone followed by oral prednisone.
Other findings
Possible role of piperine
The supplement contained black pepper extract (piperine), which is often added to turmeric to increase curcumin absorption by up to 20-fold. The authors suggest piperine may contribute to liver toxicity.
What the authors conclude
“Herbal and dietary supplements, including widely perceived “natural” products such as turmeric, should be considered in the differential diagnosis of acute hepatocellular injury.”
Also in their conclusions
- They conclude that this is among the few reported cases of biopsy-confirmed recurrent turmeric-associated immune-mediated liver injury with documented rechallenge.
- They advise that herbal and dietary supplements, including widely perceived "natural" products such as turmeric, should be considered in the differential diagnosis of acute hepatocellular injury.
- They state that re-exposure may result in more severe immune-mediated injury, underscoring the importance of thorough medication and supplement histories.
How it was done
Turmeric supplements, often combined with piperine to boost absorption, have been increasingly linked to liver injury. The authors wanted to highlight that these supplements can trigger immune-mediated liver damage that mimics autoimmune hepatitis.
They described a 65-year-old woman who took one tablespoon of a turmeric supplement containing black pepper extract daily and developed nausea and jaundice two weeks later. She had a liver biopsy and was treated with steroids.
What it can’t tell you
- This is a single case report, so it cannot prove that turmeric caused the liver injury or that it would happen to anyone else.
- It cannot show how often this reaction occurs or who might be at risk.
- It cannot determine whether the piperine, the turmeric, or another component was responsible.
Who paid
- Conflicts
- Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Authors work at
- Eisenhower Medical Center, USA
The paper
- Title
- Recurrent Drug-Induced Autoimmune-like Hepatitis due to Turmeric Supplementation
- Type
- Case report
- Evidence
- Studies in people
- Summarised from
- Full text
- Cite
- Patel AA, Dargan KK, Formaker P, Romberg C (2026). Recurrent Drug-Induced Autoimmune-like Hepatitis due to Turmeric Supplementation. Journal of investigative medicine high impact case reports. doi:10.1177/23247096261452814Free full textPubMed 42160492DOI
Summary written 26 Sep 2026. Check it against the paper before it changes what you eat. How we summarise papers · Report an error