Drug-induced hepatocellular injury due to herbal supplement ashwagandha.
- Resource Type
- Report
- Authors
- Ireland PJ; Freeman Hospital, Newcastle upon Tyne, UK.; Hardy T; Freeman Hospital, Newcastle upon Tyne, UK.; Burt AD; Royal Victoria Infirmary, Newcastle upon Tyne, UK.; Donnelly MC; Ward 16, Liver Unit, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK, Email: mhairi.donnelly@nhs.net.
- Source
- Publisher: SAGE Publications Country of Publication: England NLM ID: 101144324 Publication Model: Print Cited Medium: Internet ISSN: 2042-8189 (Electronic) Linking ISSN: 14782715 NLM ISO Abbreviation: J R Coll Physicians Edinb Subsets: MEDLINE
- Subject
- Language
- English
A 39-year-old female presented with a one-week history of jaundice and nausea after taking an over-the-counter herbal supplement containing ashwagandha root extract. Initial investigations revealed a hepatocellular pattern of liver enzyme abnormality with jaundice. Investigations, including viral serology, liver specific autoantibodies and an ultrasound scan of the abdomen, were unremarkable. Liver biopsy showed an acute cholestatic hepatitis with confluent necrosis but no features of chronicity. These histopathological findings differ to that of a previously reported case. Review of recent literature revealed that some clinical features and the time course of liver injury were similar to previous reports of ashwagandha drug-induced liver injury (DILI). The patient received treatment with ursodeoxycholic acid. We compare this case to previous reported cases of ashwagandha DILI and discuss the biochemical and histopathological features of ashwagandha DILI, therapeutic strategies and the importance of recognising herbal supplements as a possible cause of DILI.
Competing Interests: No conflict of interests declared.