Ashwagandha-Induced Hepatic Injury: A Case Report

A 22-year-old healthy Libyan female suffered moderate to severe liver injury following the ingestion of ashwagandha capsules. Following a latency period of 30 hours, she developed severe itching, fatigue, nausea, and jaundice. Laboratory results showed significantly increased liver enzymes (especially alanine aminotransferase (ALT)) and bilirubin (mainly conjugated bilirubin), along with a slight elevation of alkaline phosphatase (ALP). We used the Roussel Uclaf Causality Assessment Method (RUCAM) worksheet to link liver injury to ashwagandha. The R ratio was 5.4, and the overall RUCAM score was seven. The peaks of ALT, total bilirubin, and ALP were 315 IU/L, 12.85 mg/dl, and 150 IU/L, respectively. The washout period was 60 days. Symptoms were relieved by ursodeoxycholic acid (UDSA). The clinical assessment and workup for viral hepatitis and autoimmune hepatitis were negative. In conclusion, ashwagandha can cause prolonged hepatocellular liver injury in healthy and young individuals.