Comprehensive review of hepatotoxicity associated with traditional Indian Ayurvedic herbs

Figure 2 Granulomatous hepatitis in a patient consuming multiple Ayurvedic herbs. The retrieved herbs implicated in acute liver injury with granulomatous hepatitis are shown in A (Hygrophila auriculate, also called the Marsh Barbel and an unknown coloured herb). Transjugular liver biopsy was performed in view of ascites in this patient. The liver histology revealed large vague as well as well-formed lobular and portal based granulomas and associated eosinophilic and lymphocytic inflammation within the sinusoids [B and C; hematoxylin and eosin (H&E), 100 × and 400 × respectively]; severe feathery degeneration of hepatocytes associated with hepatocellular cholestasis was also notable (D, H&E, 400 ×). This patient died after 6 mo follow-up due to portal hypertensive events complicated by septic shock.