Acute toxic hepatitis induced by a herbal medicine : Anchusa Boraginaceae

Herbal treatments are becoming increasingly popular in many countries. Anchusa Boraginaceae (also called Tort plant and beef tongue) is commonly used as a herbal medicine in Elazıg region as diuretic and in the treatment of ulcers, and it is stated that this has no adverse effect. We report a case of acute hepatitis associated with long time use of high doses of Anchusa Boraginaceae.

A 43-year-old male patient is drinking water of Anchusa Boraginaceae that is boiling for 14 days to dissolve the stones in the gallbladder. He had no medical history and did not take any other drugs or toxins. Two weeks later ; he admitted with developed tea colored like urine and yellowing of the body. Three weeks later; he was referred to the our department from the epicenter. Blood tests showed aspartate aminotransferase : 37 U/L, alanine aminotransferase : 66 U/L, gama glutamyl transferase : 23 U/L, total bilirubin : 16.9 mg/dL, direct bilirubin : 12 mg/dL, and INR : 1.3 Viral and autoimmune hepatitis were eliminated. Upper abdominal ultrasound was normal. After the herbal medicine was stopped on admission, the patient's laboratory tests didn't recover. Then; the support treatment was performed. The clinical and the laboratory values returned to normal after 2 months after the acute episode.

The consumption of herbal medicines containing Anchusa Boraginaceae can induce toxic hepatitis. Recovery can be complete after discontinuation. This case report highlights the risk and lytic effect on gallstone associated with Anchusa Boraginaceae.