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 ${\text{mo}}^{*}$${}_{}{}^{*}\downarrow$
Time of use to discontinuation: 6 ${\text{mo}}^{*}$${}_{}{}^{*}\downarrow$
Time of presentation to the liver ${\mathit{\text{clinic}}}^{*}$		${}_{}{}^{*}\downarrow$
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