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Ashwagandha-Induced Herb-Induced Liver Injury Assessed With the Updated 2016 RUCAM
Samuel Pérez Pérez1, Erika Zumaqué-Valverde2, María Fernanda Saavedra Chacón3
1Gastrohepatology Research Group, University of Antioquia, Medellín, Antioquia, Colombia, udea.edu.co.
Case Reports in Hepatology
|July 30, 2026
Summary
Ashwagandha can cause liver injury (HILI). A systematic evaluation using the updated Roussel Uclaf Causality Assessment Method (RUCAM) confirmed probable HILI in a patient, highlighting the importance of this diagnostic approach.
Area of Science:
- Hepatology
- Pharmacovigilance
- Integrative Medicine
Background:
- Herb-induced liver injury (HILI) from Ashwagandha is increasingly recognized.
- Existing case reports often lack rigorous causality assessment and clinicopathological correlation.
- Variability in diagnostic methods complicates understanding of Ashwagandha-associated liver injury.
Purpose of the Study:
- To present a case of Ashwagandha-associated liver injury.
- To systematically evaluate causality using the updated 2016 Roussel Uclaf Causality Assessment Method (RUCAM).
- To correlate clinical and pathological findings for enhanced diagnostic confidence.
Main Methods:
- Case report of a 27-year-old female with jaundice after Ashwagandha consumption.
- Exclusion of infectious, autoimmune, and metabolic liver disease etiologies.
- Diagnostic workup including MRI and liver biopsy, with causality assessment via updated 2016 RUCAM.
Main Results:
- Liver biopsy revealed a cholestatic pattern without fibrosis.
- Updated 2016 RUCAM score of 7 indicated probable HILI.
- Patient showed clinical and biochemical improvement with symptomatic treatment, corticosteroids, and azathioprine.
Conclusions:
- This case underscores the utility of systematic causality assessment with updated RUCAM criteria.
- Comprehensive clinicopathological correlation is crucial for diagnosing HILI from herbal supplements.
- Confirms Ashwagandha as a potential cause of liver injury, necessitating careful diagnostic evaluation.