Black cohosh-induced hepatitis

Area of Science:

• Hepatology
• Integrative Medicine
• Clinical Toxicology

Background:

• Herbal products, including black cohosh, are widely used by consumers.
• Despite popularity, herbal remedies are not regulated by the Food and Drug Administration (FDA) and can cause serious side effects.
• Hepatotoxicity associated with herbal remedies is a growing concern in clinical practice.

Observation:

• A 50-year-old woman presented with symptoms of fatigue and right upper quadrant pain.
• Two weeks prior to presentation, the patient had started using black cohosh.
• Initial laboratory results indicated acute hepatitis.

Findings:

• After excluding other potential causes of liver dysfunction, the patient was diagnosed with black cohosh-induced hepatitis.
• The patient experienced a full recovery after discontinuing the herbal supplement.
• This case adds to the five previously reported instances of hepatitis or liver failure linked to black cohosh.

Implications:

• This case underscores the critical need for a comprehensive differential diagnosis in patients presenting with abdominal pain.
• It highlights the importance of a complete patient medication history, explicitly including herbal supplements.
• Healthcare providers should be aware of potential hepatotoxicity associated with herbal remedies like black cohosh.