A case of drug-induced liver injury with prolonged severe intrahepatic cholestasis induced by Ashwagandha

Abstract

A 20-year-old man with social-anxiety disorder was admitted for liver dysfunction accompanied with hyperbilirubinemia. He had used ashwagandha which he imported online in combination with multiple antianxiety drugs on his own judgment. He had taken more than twice the recommended dosage for one month before hospitalization. Drug-induced liver injury (DILI) classified as hepatocellular type by Ashwagandha was suspected, due to a score of 8 that is “high possibility” by the DDW-J 2004 DILI diagnostic criteria. Hyperbilirubinemia became exacerbated despite the cessation of ashwagandha and concomitant drugs. Histological findings revealed many canalicular bile plugs. His liver function was normalized after initiation of ursodeoxycholic acid and phenobarbital Here we reported a rare case of DILI with hyperbilirubinemia caused by Ashwagandha It is facile to obtain even designated drugs such as ashwagandha by distribution system in the present day. More widely and efficient information system for attention might be needed.