Case Report
Liver Injury with Features Mimicking Autoimmune Hepatitis following the Use of Black Cohosh
Table 3
Duration of Illness and black cohosh use, liver function tests, autoimmune markers, histology, and treatment.
| Case |
| Time of use to illness: 6 | | | | | | |
| Time of use to discontinuation: 6 | | | | | | |
| Time of presentation to the liver | | | | | | |
| Duration of illness in months | 2 | 4 | 7 | 12 | 15 | 40 | Treatment | — | Prednisone | Azathioprine | — | — | — |
| Liver function tests (normal) | | | | | | | Total bilirubin (0.8–1.2 mg/dL) | 3.1 | 1.4 | 1.8 | 0.9 | 1.0 | 0.8 | ALT (5–40 U/L) | 1457 | 334 | 321 | 30 | 39 | 37 | AST (10–40 U/L) | 696 | 229 | 236 | 29 | 37 | 33 | ALP (30–120 U/L) | 94 | 68 | 66 | 36 | 38 | 37 | INR (0.8–1.2) | 1.2 | 1.17 | — | 0.95 | — | 0.92 |
| Autoimmune antibodies | | | | | | | Antinuclear antibody | 1 : 40 | 1 : 20 | — | — | — | — | Antismooth muscle antibody | 1 : 80 | — | — | — | — | — | Liver biopsy findings | — | Acute hepatitis | Chronic hepatitis | — | Biopsy at 15 mo. |
| Lobular | | | | | Necrosis | — | Central & portal | — | — | Absent | Infiltrates | — | Mixed with eosinophils | Plasmacytic | — | Absent | Other findings | — | Disarray, ballooning Apoptosis | | — | No significant abnormality |
| Portal and periportal | | | | | Cholangiolar proliferation | — | Moderate | Moderate | — | Absent | Infiltrate severity | — | Moderate | Moderate | — | Minimal | Infiltrate predominant type | — | Mixed with eosinophils | Plasmacytic | — | Lymphocytes | Fibrosis | — | Fibronecrosis | Fibronecrosis | — | Absent |
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