Siddique AS, Siddique O, Einstein M, Urtasun-Sotil E, Ligato S. Drug and herbal/dietary supplements-induced liver injury: A tertiary care center experience. World J Hepatol 2020; 12(5): 207-219 [PMID: 32547688 DOI: 10.4254/wjh.v12.i5.207]
Corresponding Author of This Article
Ayesha S Siddique, MD, Doctor, Department of Pathology and Laboratory Medicine, Hartford Hospital, 85 Seymour Street, Hartford, CT 06102, United States. firstname.lastname@example.org
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2Contains caffeine, lady's mantle extract (Alchemilla vulgaris), wild olive extract (Olea europaea), cumin extract (Cuminum cyminum), wild mint extract (Mentha longifolia), and, in some products, green coffee bean extract (Coffea canephora).
3CarnoSyn Beta Alanine to support muscular endurance, TeaCrine to prolong tolerance buildup, Rauwolfia, and Toothed Clubmoss.
4Highly active antiretroviral therapy.
5Not previously reported.
6Unusual patterns for this drug/HDS. HDS: Herbal/Dietary supplements; BCG: Bacillus Calmette Guerin.
Table 4 Clinical features, histopathological patterns and outcomes of patients presenting with previously unreported drugs/HDS or with unusual pattern of injury
Total Bilirubin (mg/dL)
Platelet count (/µL)
Acute hepatocellular and canalicular cholestasis associated with bile duct damage, mild steatohepatitis with portal, periportal and pericentral fibrosis (stage 2 of 4), and nodular regenerative hyperplasia
LFTs downtrended after 15 d of drug removal
Moderate to severe acute hepatitis with associated cholestasis and bile duct damage
LFTs downtrended after 45 d of drug removal
Cholestatic hepatitis with portal and lobular mononuclear inflammatory infiltrate, bile duct damage and bile ductular proliferation
Pericentral hepatocyte and canalicular cholestasis, bile duct injury with bile ductular proliferation, mixed portal inflammatory infiltrates, mild interface hepatitis, lobular necroinflammatory activity with ballooning degeneration; mild macro and microvesicular steatosis
LFTs downtrended after 85 d of drug removal
Severe cholestatic hepatitis with sub massive hepatic necrosis involving approximately 70% of the liver parenchyma accompanied by severe centrilobular congestion, necrosis and extravasation of red blood cells
Underwent transplant; Alive and doing well
Cholestatic hepatitis with bile duct injury and steatosis
Citation: Siddique AS, Siddique O, Einstein M, Urtasun-Sotil E, Ligato S. Drug and herbal/dietary supplements-induced liver injury: A tertiary care center experience. World J Hepatol 2020; 12(5): 207-219