Liver Injury with Features Mimicking Autoimmune Hepatitis following the Use of Black Cohosh

Table 4

Duration of Illness and black cohosh use, liver function tests, autoimmune markers and histology.

Case $2$
Time of use to illness: 8 ${months}^{*}$	${}^{*}\downarrow$
Time of use to discontinuation: 8 ${months}^{*}$	${}^{*}\downarrow$
Time of presentation to liver ${clinic}^{*}$		${}^{*}\downarrow$
Duration in months	4	4.5	5
Treatment		Prednisone
Liver function tests (normal values)
Total bilirubin (0.8–1.2 mg/dL)	2.0	1.4	0.6
ALT (5–40 U/L)	443	60	30
AST (10–40 U/L)	478	50	38
ALP (30–120 U/L)	188	153	98
INR (0.8–1.2)	2.0	—	1.3
Autoimmune antibodies
Anti-nuclear antibody	Negative	1 : 20	—
Anti-smooth muscle antibody	Negative	—	—
Liver biopsy findings		—	—
Lobular
Necrosis	Central	—	—
Infiltrates	Plasmacytic	—	—
Other findings	Disarray, apoptosis	—	—
Portal and periportal
Cholangiolar proliferation	Moderate	—	—
Infiltrate severity	Moderate	—	—
Infiltrate predominant type	Plasmacytic	—	—
Fibrosis	Fibronecrosis	—	—