Case Report

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

Table 6

Similarities and differences among current case studies and published cases of black cohosh hepatotoxicity.

Case reportsWhiting Case 1*Whiting Case 2*Lontos*Levitsky*Cohen*Lynch*ChowNisbetCurrent study Case 1##ā€‰ā€‰Current study Case 2


Botanical dietary contentsBlack cohoshBlack cohosh, skullcap#, Valerean, PassionflowerBlack cohosh, ground ivy#, golden seal, Gingko, oat seedBlack cohoshBlack cohoshBlack cohoshBlack cohoshBlack cohoshBlack cohoshBlack cohosh, soy

Other drugs LevothyroxineLevothyroxineLevothyroxineDicyclomine

Serologies indicating presence of other liver diseasesAbsentAbsentAbsentAbsentAbsent

Lab data indicating presence of other liver diseasesAbsentAbsentAbsentAbsentAbsent

Presenting symptomJaundiceALFALFALFJaundiceAcute hepatitisAcute hepatitisRUQ pain

Main liver biopsy findingAcute hepatitisAcute hepatitisMassive liver necrosisCentrilobular necrosisCentrilobular necrosis

Lobular infiltrateMixed + plasma cellsMononuclear infiltratePlasma cytic infiltrateLymphop-lasmacytic infiltrate
Other lobular findingsNecrosisBridging necrosisPreserved bile ducts, collapsed parenchymaLobular disarray Lobular disarray

TherapyPrednisoneImmuno-therapyPrednisonePrednisone & azathioprinePrednisone

InterventionOLTOLTOLTOLTWithdrawal of black cohoshWithdrawal of black cohoshWithdrawal of black cohosh

OutcomeRecoveryLF s/p d/c black cohoshRecoveryRecoveryLF death hemorrhageRecoveryRecoveryRecoveryRecovery
AIH like histologyPresentPresentPresentPresentPresent

Serological marker for AIHAbsent AbsentAbsentAbsentAbsentAbsent

Issues disputing validity of black cohosh hepatoxicityDrug use for only 6 daysMulti-drug productMulti-drug productMulti drug use Ethanol, NSAID & cyclovir7 day use; maybe AIH2 weeks exposure; cholelithiasisMaybe AIH

*Cases adapted from Table 1 Lynch [5]; ALF: Acute liver failure; RUQ: Right upper quadrant pain.
OLT: Orthotopic liver transplant; LF: Liver failure.
#Herbal remedies known as hepatotoxic; ##Also reported by Mahady [9]; AIH: Autoimmune hepatitis.