Black Cohosh Hepatotoxicity with Autoimmune Hepatitis Presentation

Area of Science:

• Hepatology
• Integrative Medicine
• Toxicology

Background:

• Herbal medicines, including Black cohosh (BC), are widely used for menopausal symptom relief.
• Evidence regarding the safety and efficacy of BC for postmenopausal symptoms is conflicting.
• Hepatotoxicity is a potential concern with certain herbal supplements.

Observation:

• A 69-year-old female presented with symptoms indicative of liver injury.
• The patient had a history of using Black cohosh supplements.
• Clinical and laboratory findings suggested an autoimmune process affecting the liver.

Findings:

• The case presented is the third documented instance of Black cohosh-induced autoimmune hepatitis (AIH).
• Hepatotoxicity was confirmed, directly linked to the consumption of Black cohosh.
• The findings indicate a potential causal relationship between BC and AIH.

Implications:

• This case underscores the importance of considering drug-induced liver injury when evaluating patients using herbal remedies.
• Healthcare providers should counsel patients on the potential risks associated with Black cohosh, especially concerning liver health.
• Further research is warranted to elucidate the mechanisms of BC-induced hepatotoxicity and AIH.