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A 65-year-old woman with breast cancer treated 18 years earlier was admitted for obstructive jaundice for 2 weeks. She started using garcinia cambogia 3 months ago for weight loss. Physical exam showed scleral icterus. Serum studies excluded Wilson's disease, systemic infection including COVID-19 (coronavirus disease 2019), autoimmune hepatitis, and metabolic or toxicologic causes. An urgent liver biopsy showed severe giant cell hepatitis in absence of HSV-1\/2, cytomegalovirus, HBsAg and HBcAg (immunostain), and EBV (in situ hybridization). Despite supportive therapy, the patient developed grade 2\u20133 hepatic encephalopathy and necessitated liver transplant. The explanted liver was markedly atrophy, in which the most striking histologic finding was diffuse distribution of multinucleated giant hepatocytes with syncytial pattern in a background of extensive zone-1 accentuated, geographic, hemorrhagic, confluent hepatocytic necrosis, along with remarkable hepatocytic and canalicular cholestasis. Marked hepatocellular and sinusoidal iron orverload present. The patient recovered uneventfully.<\/jats:p>","DOI":"10.1177\/10668969231186926","type":"journal-article","created":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T02:17:56Z","timestamp":1689646676000},"page":"619-624","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Striking Cholestatic Giant Cell Hepatitis Resulting in Fulminant Liver Failure After Garcinia Cambogia Use"],"prefix":"10.1177","volume":"32","author":[{"given":"Elizaveta","family":"Flerova","sequence":"first","affiliation":[{"name":"Thomas Jefferson University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manju","family":"Ambilil","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse M.","family":"Civan","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Sass","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warren R.","family":"Maley","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv","family":"Pulinthanathu","sequence":"additional","affiliation":[{"name":"Department of Pathology, Cooperman Saint Barnabas Medical Center, Livingston, NJ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4406-7293","authenticated-orcid":false,"given":"Jialing","family":"Huang","sequence":"additional","affiliation":[{"name":"Geisinger Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,7,17]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.5009\/gnl15114"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2014-0214-RA"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.23937"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v25.i46.6704"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gtc.2017.01.004"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14271"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.2174\/1389200221666200420100129"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.curtheres.2003.08.006"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fitote.2007.12.003"},{"key":"e_1_3_2_11_2","unstructured":"Garcinia Cambogia in LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. 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