Single case report, consent obtained

Case report poster

A case report poster is a story with laboratory values, and the layout should number the story so a reader never hunts for what happened next. This A0 portrait example runs six numbered stages down a rail, from presentation with an ALT of 1,480 to recovery at 96 by day 21, with one chart carrying the whole clinical course.

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The whole board

The poster at full size, exactly as it prints. Every number, citation and caption on it was written for this example, so the layout is being judged on real content.

SAH
Herbal supplement induced liver injury in a 34 year old: recognition, withdrawal and recovery over 21 days
D. Osei ¹, F. Lindahl ¹, H. Rasmussen ¹
1 Department of General Medicine, St Aldric's Hospital
1
PRESENTATION
A 34 year old woman presented with two weeks of fatigue, nausea and progressive jaundice. She drank no alcohol, took no prescription or over the counter medicines, and had no personal or family history of liver disease. Directly asked, at the second visit rather than the first, she reported a green tea extract weight loss supplement started six weeks earlier, 1,200 mg daily from an online retailer. On day 0 her ALT was 1,480 U/L, roughly forty times the upper reference limit, with bilirubin 61 micromol/L and INR 1.1. She was admitted for observation, and the supplement was the only exposure the history produced. Written consent for this report was obtained from the patient before submission.
2
BACKGROUND
Herbal and dietary supplements now account for a meaningful share of drug induced liver injury presentations, with concentrated green tea extract among the most consistently implicated ingredients. These injuries are missed for a simple reason: patients do not consider supplements to be drugs, and clinicians who ask about medicines do not always ask the second question. The typical pattern is hepatocellular, an ALT rise far out of proportion to alkaline phosphatase, in a young adult with no other risk factors, precisely the presentation here. A single case cannot establish causality, but a well documented one can show the shape of recognition, structured assessment and recovery on withdrawal, which this board sets out day by day.
3
METHODS
History. Supplement dose 1,200 mg green tea extract daily for six weeks; no alcohol, no other drugs, no recent travel or transfusion.
Examination. Jaundiced, no encephalopathy, no ascites, no stigmata of chronic liver disease; liver edge mildly tender.
Tests. ALT, bilirubin and INR daily; hepatitis A to E, EBV, CMV and autoimmune screens negative; ultrasound normal with patent vessels.
Causality. RUCAM score 8, probable. Timing, injury pattern, exclusion of alternatives and improvement on withdrawal all scored.
Management. Supplement withdrawn on day 0, supportive observation only, no steroids; regulator report filed with the sample retained.
4
COURSE
Withdrawal was the only intervention, and the numbers turned within days. ALT fell from 1,480 U/L on day 0 to 1,210 by day 3, 760 by day 7, 320 by day 14 and 96 by day 21, near normal three weeks after the last capsule. Bilirubin lagged the way it usually does, peaking at 84 micromol/L on day 4 before falling to 22 by day 21, and the INR never rose above 1.3, so synthetic function was preserved throughout and transplant criteria were never approached. She was discharged on day 6 once the trajectory was established, with twice weekly bloods as an outpatient. Symptoms resolved in step with the biochemistry: appetite returned in the first week and the jaundice faded through the second. Figure 1 carries the whole story in two lines.
ALT (U/L)
Bilirubin (micromol/L)
Day 0
Day 3
Day 7
Day 14
Day 21
040080012001600
Figure 1. ALT (U/L) over 21 days after supplement withdrawal, with bilirubin (micromol per L) as the second series peaking on day 4.
Source: Trial dataset, 2026.
5
WHAT THIS CASE SHOWS
Three features make the attribution respectable rather than reflexive. The timing fits: onset six weeks into a known hepatotoxic ingredient and recovery beginning within days of withdrawal. The workup was completed, with viral, autoimmune and structural causes excluded before the supplement was blamed. And the RUCAM score of 8 puts the case in the probable range on a structured instrument rather than on clinical instinct; no rechallenge was attempted, which is why certainty is not claimed. The cue that was nearly missed is the transferable lesson: the supplement surfaced only when a direct question was asked at the second visit. The injury was two weeks old by then; an earlier question would have meant an earlier withdrawal.
6
TAKE HOME
Ask about supplements at every liver screen, by name and dose, not with a general question about medicines: patients do not volunteer what they do not consider a drug. In this case withdrawal alone led to full biochemical recovery in 21 days, with no steroids and no lasting deficit. Assess causality with a structured tool rather than an impression; the RUCAM here scored 8, probable. And close the loop beyond the ward: the case was reported to the medicines regulator with the product sample retained, because the next patient is protected by the report, not by the discharge summary. Finally, confirm the recovery: bloods at three months confirmed normalisation, and the written advice named the exact ingredient to avoid for life.
REFERENCES
1.Osei D, Lindahl F. Green tea extract and hepatocellular injury: a case series from one centre. Clinical Hepatology Letters 2025;13(2):91-104.
2.Rasmussen H, Osei D. Applying RUCAM at the bedside: a worked scoring example. Hepatology Practice Notes 2024;7(1):33-45.
3.Lindahl F, Whitcombe A. Supplement histories in acute medicine: what patients do not volunteer. General Medicine Briefs 2023;5(3):140-152.

Block by block

What each block on the board is for, in the order a reader walks it.

Title band and authors
The title compresses the case into its arc: recognition, withdrawal and recovery over 21 days. All three authors share the one hospital affiliation, and the two QR codes on this layout both link to the full case timeline and the causality worksheet.
1 Presentation
The first rail stage carries the presentation as an abstract: a 34 year old woman with two weeks of fatigue and jaundice, no alcohol, no other medicines, a green tea extract supplement started six weeks earlier, and an ALT of 1,480 on day 0. Consent for the report is stated here, not assumed.
2 Background
Stage two explains why these injuries are missed: patients do not consider supplements to be drugs, and clinicians who ask about medicines do not always ask the second question. It also names the typical pattern, a hepatocellular ALT rise in a young adult with no other risk factors.
3 Assessment
The methods protocol carries the workup in five labelled entries: the supplement history with dose, the examination, the daily bloods with negative viral and autoimmune screens and a normal ultrasound, the RUCAM score of 8, probable, and the management decision, withdrawal and observation only.
4 Course, with the ALT curve (Figure 1)
The results stage prints the numbers, ALT 1,480 to 1,210 to 760 to 320 to 96 across 21 days, bilirubin peaking at 84 on day 4, INR never above 1.3, discharge on day 6. The line chart below shows both series, and the fall beginning within days of withdrawal is the case.
5 What this case shows
The discussion stays with this patient: timing fits, alternatives excluded, RUCAM in the probable range, no rechallenge so causality is argued, not proven. The transferable lesson is the missed cue, the supplement surfaced only when a direct question was asked at the second visit.
6 Take home
The final stage gives the three instructions the case earns: ask about supplements by name and dose at every liver screen, use a structured causality tool, and report to the regulator with the sample retained. Recovery confirmed at three months closes the story properly.
References
The three references are invented for this fictional study, because the reference block is required on this layout; on your board, replace them with your sources. For a real case report the three slots usually go to the causality tool, the relevant injury registry and the closest published case.
How to adapt this board
Map your case onto the six numbered stages, presentation, background, assessment, course, meaning, take home, and resist adding a seventh. Chart the one marker that carries your story, with a second series only if it adds meaning, and state consent and the causality score on the board itself.

What makes this board work

Six stages, read top to bottom

The numbered rail walks the reader from presentation to take home in order, so the narrative never depends on guessing which block comes next, which is the failure mode of most case posters.

One marker, five points

The ALT curve, 1,480 down to 96 over 21 days with bilirubin as the second series, is the entire evidence of recovery in one chart, and every value on it reappears in the course text.

Consent and causality are printed

Written consent is stated in the presentation stage and the RUCAM score of 8 sits in the assessment protocol, which are the two things a meeting reviewer checks before reading anything else.

Questions people ask

What goes on a case report poster?

Presentation, background, assessment, course, what the case shows and a take home, with patient consent stated. This board gives each its own numbered stage on the rail, and the one figure charts the marker that proves the course. The full record belongs behind the QR code.

Do I need a figure on a case poster?

One chart of the key marker over time is usually the strongest evidence a case has; this layout carries exactly one figure slot and this board uses it for ALT with bilirubin as a second series. If your case turns on imaging rather than a trend, describe the finding and link images by QR.

Can I add an imaging picture?

No poster layout has a fillable image slot, so scans cannot appear on the board. This case needed only a normal ultrasound, reported in one assessment entry. For an imaging led case, report the finding in words on the board and put the annotated images behind the QR code.

Where does the causality score go?

In the assessment protocol with its value and category, as this board does with RUCAM 8, probable. Scoring is what separates an attributed case from an anecdote, and printing the score invites the reader to check the elements rather than accept an impression.

How much literature belongs on the board?

One background stage and three references. The rail layout enforces the discipline: background is a single stage among six, so the literature frames the case rather than swallowing it. A systematic review of similar cases is a different poster on a different layout.

Is patient consent required on the board?

Yes, state it. Most meetings require written consent for a recognisable case, and stating it on the board, as this example does in the presentation stage, answers the question before it is asked. Where consent could not be obtained, follow your meeting rules and say what applies.

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Sources

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