Comprehensive review of hepatotoxicity associated with traditional Indian Ayurvedic herbs

Figure 6 Hepatic sinusoidal obstruction syndrome in a young male who consumed Holarrhena antidysenterica, known to contain pyrrolizidine alkaloids. Transjugular liver biopsy was performed in view of ascites. The liver histology showed fairly preserved portal areas with extensive sinusoidal dilatation in all zones associated with early sinusoidal and peri-sinusoidal fibrosis [A and B, hematoxylin and eosin (H&E) stain, 400 ×]; the sinusoidal fibrosis is quite evident on Masson-trichrome stain (C, 400 ×); after one year follow-up, in view of recurrence of ascites and acute variceal bleeding, a repeat liver biopsy was performed which revealed prominent sinusoidal dilatation with sinusoidal and portal fibrosis (D, H&E stain, 200 ×) and cirrhosis changes with bridging fibrosis and partial nodule formation (E, Masson-trichrome stain, 200 ×). The retrieved over-the-counter herbal supplement is shown (F).