Drug-Induced Hepatocellular Injury Due to Herbal Supplement Ashwagandha

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 se...

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Bibliographic Details
Published in:The Journal of the Royal College of Physicians of Edinburgh 2021-12, Vol.51 (4), p.363-366
Main Authors: Ireland, Peter J, Hardy, Timothy, Burt, Alastair D, Donnelly, Mhairi C
Format: Article
Language:English
Subjects:
Adult
Carcinoma, Hepatocellular
Dietary Supplements - adverse effects
Female
Humans
Liver Neoplasms
Plant Extracts - adverse effects
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Summary: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.
ISSN:1478-2715
2042-8189
DOI:10.4997/jrcpe.2021.409