Figure 1. Image 1: Renal Biopsy showing TMA: (A) mesangiolysis and endothelial cell swelling. (B) acute tubular injury, with tubular thinning and reactive nuclear changes. Interstitial edema and mixed interstitial inflammation. (C) fibrin thrombi and neutrophils within the capillary loops. RBC fragmentation is evident here within capillary loops and the mesangium.
transplantation. Our patient's unrevealing workup, his spontaneous improvement correlating with supplement discontinuation, and RUCAM score of 7 led to high suspicion of DILI secondary to artemisinin. Providers should always ask patients about supplement use and consider DILI when patients present with liver injury.Table 1. The patient's laboratory values, including total bilirubin, alkaline phosphatase (ALP), aspartate transaminase (AST), and alanine transaminase (ALT) improved after stopping Artemisinin/Bioperine
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