S3229 A Case of Cholestatic Drug-Induced Liver Injury After Ashwagandha Root Supplementation

Abstract

Figure 1. a & b. Some lipogranulomas are shown in portal tracts (left). In addition, hepatocyte focal necrosis evidenced by hepatocyte dropout and replaced with mononuclear cells and macrophages mixed with lipogranulomas are identified in the lobule (right). No dense lymphoid aggregate was identified, a typical feature for HCV. An unusual finding in acute cellular rejection, points to the recurrent HCV infection. c. Mild to focal moderate mixed inflammatory cell infiltrate seen in most portal tracts/areas, including neutrophils, mononuclear, eosinophils, and plasma cells, associated with scattered interface hepatitis. Focal endotheliitis is evidenced by inflammatory cells undermining the endothelial cells. Interlobular bile duct injury is focal and mild. Feature of Mild acute cellular rejection. d. Trichrome stain shows no delicate periportal strands of "chicken wire" like pericellular fibrosis; an early fibrosing cholestatic hepatitis is still under consideration.