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 1

Time of use to illness: 6 mo**

Time of use to discontinuation: 6 mo**

Time of presentation to the liver clinic**

Duration of illness in months247121540

Liver function tests (normal)
 Total bilirubin (0.8–1.2 mg/dL)
 ALT (5–40 U/L)1457334321303937
 AST (10–40 U/L)696229236293733
 ALP (30–120 U/L)946866363837
INR (0.8–1.2)

Autoimmune antibodies
 Antinuclear antibody1 : 401 : 20
 Antismooth muscle antibody1 : 80
Liver biopsy findings Acute hepatitisChronic hepatitisBiopsy at 15 mo.

 NecrosisCentral & portalAbsent
 InfiltratesMixed with eosinophilsPlasmacyticAbsent
 Other findingsDisarray, ballooning ApoptosisNo significant abnormality

Portal and periportal
 Cholangiolar proliferationModerateModerateAbsent
 Infiltrate severityModerateModerateMinimal
 Infiltrate predominant typeMixed with eosinophilsPlasmacyticLymphocytes
Fibrosis FibronecrosisFibronecrosisAbsent