INTRODUCTION: Kombucha “mushroom” tea, sold in popular health food stores, is touted to have healing properties, including boosting immunity in HIV. Here, we present a case of severe hyperthermia, lactic acidosis, and acute renal failure in a 22 year old male within 15 hours of Kombucha tea ingestion.
CASE PRESENTATION: A 22 year old Filipino gay male with a recent diagnosis of HIV, was seen in the ER after developing acute onset of shaking fevers and chills. One week prior to admit, the patient purchased a bottle of unpasteurized Kombucha tea, as he believed it could boost his immune system. The patient consumed this tea the night before admission, sharing a 1 liter bottle with an HIV negative friend. His life partner reports he had a tactile temperature that night, though appeared well in the morning. Eight hours later, the patient began shaking uncontrollably, became short of breath and was febrile to 103.0F. Review of systems was otherwise negative. The patient was diagnosed with HIV two weeks prior to admit, at which time his CD4 count was 414. HAART had not been initiated. He also has known anaphylaxis to peanuts. Both he and his life partner adamantly denied alcohol, tobacco, or illicit drug use. In the ER, the patient was febrile to 104.1F, HR 180s, BP 192/105. The patient became combative and confused, requiring sedation and intubation for airway control. Pupils were dilated but reactive. Neurological assessment was nonfocal. The remainder of his physical exam was negative.Laboratories revealed a lactate of 12.9, ammonia level 214, AST 57. LFTs were otherwise normal. ABG showed 7.32/31/446/16/100%. Chemistries showed a bicarb 16, AG 25, and Cr 2.1. Urine toxin and ethanol levels were negative. Head CT was negative. Lumbar puncture testing was normal. Empiric antibiotic therapy for meningitis and encephalitis was initiated and quickly discontinued, per infectious disease recommendations, as the patient remained afebrile after admit without evidence of infection. Within 36 hours of Kombucha tea ingestion, the patient dramatically improved with supportive care. He was extubated and discharged home on hospital day #2.
DISCUSSIONS: Kombucha “mushroom” tea, synonymous with Manchurian or Kargasok tea, is fermented black tea in a yeast-bacteria medium. In the HIV community, it is popular for its reported ability to improve T cell counts. These claims have not been confirmed via objective scientific investigation. Review of the literature reveals little data on the medicinal effects, side effects, or potential toxicity of this tea. There are several case reports of serious, and in some instances, fatal, hepatic dysfunction and lactic acidosis, within close proximity to Kombucha tea ingestion. Microbiological studies have revealed evidence of numerous types of yeast and bacteria present during the fermentation process, including Aspergillus. Leeching of toxic material into this tea during the fermentation process, particularly with home-brewed tea, is of particular concern. Lead toxicity has been linked to fermentation of Kombucha tea in a lead-based ceramic pot.
CONCLUSION: While Kombucha tea is considered a healthy elixir, there currently is no scientific data to support this claim. The limited evidence currently available raises considerable concern that Kombucha tea may pose serious health risks, particularly in the immunodeficient population. Consumption of this tea should be discouraged, as it may be associated with life-threatening lactic acidosis.
DISCLOSURE: Alison Kole, None.