Response to “Acute Hepatitis Induced by Lyprinol, the Lipid Extract of the Green-Lipped Mussel (Perna canaliculus), in a Patient with Polyarthrosis”

Table 1

CIOMS/RUCAM score for the case report on acute hepatitis induced by Lyprinol.

Scale item	Scoring criteria	Score
(1) Time of onset	Time from drug intake to reaction: first exposure 5–90 days	+2
(2) Course	Greater than 50% improvement in 8 days	+3
(3) Risk factors	Age over 55 years +1/alcohol—unknown	+1
(4) Concomitant drugs	Concomitant drug known as hepatotoxin and with comparable or suggestive time of onset
(5) Alternative nondrug causes*	Group 1: HAV serology +ve/alcoholism—unknown = 0; Group 2: Auto-immune polyarthropathy possible = −3	to 0
(6) Previous hepatotoxic information	Reaction published but unlabelled	+1
(7) Response to rechallenge	Not undertaken	0
Total score		2–5
Interpretation: unlikely (2) to possible (5)

* Explanation for variation on scale item 5—alternative nondrug causes: the RUCAM outlines two groups of nondrug causes of acute hepatitis that need to be considered which are divided into two groups. Group 1 consists of recent HAV, HBV, or HCV; biliary obstruction; alcoholism; or history of hypotension (particularly if there is underlying heart disease). Group 2 consists of complications of underlying disease and clinical or biological context for CMV, EBV, or herpes virus infection. A score of 0 is given for 5 or 4 of Group 1 being excluded and −3 given if a nondrug cause such as acute autoimmune polyarthropathy is highly probable.