Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2015; 7(2): 285-288
Published online Feb 27, 2015. doi: 10.4254/wjh.v7.i2.285
Lesser celandine (pilewort) induced acute toxic liver injury: The first case report worldwide
Bulent Yilmaz, Barış Yilmaz, Bora Aktaş, Ozan Unlu, Emir Charles Roach
Bulent Yilmaz, Ozan Unlu, Emir Charles Roach, Department of Gastroenterology, School of Medicine, Hacettepe University, 06100 Ankara, Turkey
Barış Yilmaz, Bora Aktaş, Department of Gastroenterology, Diskapi Yildirim Beyazit Education and Research Hospital, 06330 Ankara, Turkey
Author contributions: All authors were involved in the clinical management of the patient, as well as drafting and revision of the manuscipt.
Informed consent: The patient in this study provided informed written consent prior to study enrollment.
Conflict-of-interest: The authors certify that no author in this paper has any conflict of interest with any commercial, personal, political, intellectual, religious or any other kind of organization regarding the material discussed in the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bulent Yilmaz, MD, Department of Gastroenterology, School of Medicine, Hacettepe University, Rektörlüğü Beytepe, 06100 Ankara, Turkey. dr.yilmazbulent@gmail.com
Telephone: +90-505-2993076 Fax: +90-312-3055000
Received: November 16, 2014
Peer-review started: November 16, 2014
First decision: November 27, 2014
Revised: December 28, 2014
Accepted: January 9, 2015
Article in press: Janurary 12, 2015
Published online: February 27, 2015
Processing time: 88 Days and 20.1 Hours
Abstract

Lesser celandine, also known as Ranunculus ficaria, is a herbaceous perennial plant that commonly utilizes piles and is taken either internally or used externally. The causality assessment of several reports provided evidence for the existence of Greater Celandine hepatotoxicity. However, there hasn’t been any case report published thus far, about lesser celandine induced liver injury. Here, we present a case of 36-year-old woman admitted to the hospital with acute hepatitis and jaundice on her sclera with no history of drug abuse or alcohol consumption. However, the patient had a recent history of lesser celandine extract consumption for hemorrhoids, for about 10 d, prior to the admission. Viral hepatitis, autoimmune hepatitis, and drug induced toxic hepatitis were ruled out by further imaging studies and laboratory analysis. Using the Council for International Organizations of Medical Sciences scale, the type of liver injury was assumed as hepatocellular and was scored as 7 which shows probable causality. Immediate discontinuation of lesser celandine extract resulted in rapid decrease of the elevated enzymes. Herbs have been reported to cause liver injury and therefore should be suspected in the case of acute hepatitis with an unknown etiology. This case is important to be the first to explain hepatotoxicity caused by lesser celandine. Physicians should consider lesser celandine as a causative agent for hepatotoxicity.

Keywords: Celandine; Acute liver toxicity; Hepatitis; Pilewort; Herb

Core tip: Herbs have been reported to cause liver injury and therefore should be suspected in the case of acute hepatitis with an unknown etiology. This case is the first to explain hepatotoxicity caused by lesser celandine. Physicians should consider lesser celandine as a causative agent for hepatotoxicity.