Ashwagandha‐induced acute liver injury: A case report

Abstract

Drug-induced liver injury became one of the most important liver disorders and diagnostic challenge for clinicians and pathologists. Here, we report a rare case of ashwagandha-induced acute liver injury. The patient developed jaundice 2 weeks after starting ashwagandha intake and recovered within 5 months after withdrawal without any specific treatment.

Herb-Induced Liver Injury by Ayurvedic Ashwagandha as Assessed for Causality by the Updated RUCAM: An Emerging Cause

“…Since then, ashwagandha-induced hepatotoxicity has been reported worldwide [ 22 ]. To our knowledge, most cases of liver injury associated with ashwagandha use have been reported in Europe [ 14 , 15 , 16 , 21 , 22 ]. From 2021 there has also been an increase in the European Rapid Alert System for Food and Feed notifications concerning ashwagandha supplements, especially those sold online [ 25 ].…”

“…Further, Weber and Gerbes (2021) presented a case of a 40-year-old man from Germany with acute liver injury, who took 500 mg of ashwagandha extract for over a year, then switched to 450 mg of Ashwagandha for 20 days [ 16 ]. In another case report from Germany [ 21 ], a 65-year-old woman had been taking ashwagandha for 4 weeks before admission, but the dose was not reported. Unknown doses and quality of the ashwagandha supplement were also reported in papers by Lubarska et al [ 22 ] and Suryawanshi et al [ 23 ].…”

“…In all these cases, other causes of liver diseases were ruled out, and no cases of death have been reported so far. Only in the cases reported by Weber and Gerbes [ 16 ] and Toth et al [ 21 ] was a liver biopsy performed. None of the patients had severe complications such as encephalopathy or coagulopathy, and the recovery started soon after the ashwagandha had been withdrawn.…”

“…Based on the reported R-value, three patients developed a mixed type of liver injury, including two cholestatic types, and three patients had a hepatocellular type of liver injury ( Table 1 ). For two patients, the R-value was not reported [ 16 , 21 ]. Weber and Gerbes [ 16 ] presented a case of acute liver injury in a 40-year-old man manifested by progressive hyperbilirubinemia and an increase in liver transaminases without previous comorbidities, without specifying the type of liver injury.…”

“…Weber and Gerbes [ 16 ] presented a case of acute liver injury in a 40-year-old man manifested by progressive hyperbilirubinemia and an increase in liver transaminases without previous comorbidities, without specifying the type of liver injury. Toth et al [ 21 ] reported prominent hepatocellular and canalicular cholestasis and spotty hepatocellular necrosis accompanied by multiple ceroid-laden macrophages in the perivenular parenchyma. Suryawanshi et al [ 23 ] reported acute liver failure with an R-value > 5 that ended with LT.…”