[Necrotizing hepatitis after taking herbal remedies]

Area of Science:

• Hepatology
• Toxicology
• Integrative Medicine

Background:

• Acute hepatitis of uncertain etiology can be challenging to diagnose.
• Recurrent liver injury necessitates a thorough investigation into potential causative agents.
• Herbal remedies are increasingly used as alternative medications, warranting scrutiny for potential adverse effects.

Observation:

• Two women presented with recurrent acute hepatitis.
• Both patients had a history of elevated liver enzymes (GPT) and liver biopsy confirmed acute necrotizing hepatitis.
• Hepatitis episodes were preceded by the consumption of herbal remedies: kava in one patient and common celandine in the other.

Findings:

• Viral, autoimmune, and metabolic causes of hepatitis were excluded in both cases.
• Liver function tests normalized rapidly after discontinuation of the suspected herbal preparations.
• A causal link between kava and common celandine intake and acute hepatitis recurrence is strongly suspected.

Implications:

• This study highlights the potential hepatotoxicity of certain herbal remedies.
• Clinicians should inquire about herbal supplement use in patients with unexplained liver injury.
• Further research is needed to elucidate the mechanisms of herbal-induced liver damage.