Uncommon cause for a common disease-Severe steatohepatitis secondary to Ayurvedic ‘Man-Lion Tonic’

Narasimha Rasayana (Sanskrit for ‘Man-Lion Tonic’) is a frequently prescribed Ayurvedic herbal medicinal preparation in South India for treatment of fatigue, hair loss, rejuvenation and weight gain in young men and women. The preparation is also considered, as per Vedic medical literature known as Ashtanga Hridayam Uttara to improve fertility by acting as an aphrodisiac. We present the interesting case of a young male, who consumed 2 tablespoons (~15 grams) of the ‘Man-Lion Tonic’ daily for 2 years, presenting with loss of appetite and well-being and elevated transaminases with liver histology showing overlapping features unique to spectrum of acute alcohol liver injury not described with CAM before.