Ewha Med J.  2014 Mar;37(1):60-63. 10.12771/emj.2014.37.1.60.

Chelidonium majus-Induced Acute Hepatitis

• Im SG
• Yoo SH
• Jeon DO
• Cho HJ
• Choi JY
• Paik S
• Park YM

• KMID: 2171277
• DOI: http://doi.org/10.12771/emj.2014.37.1.60

Abstract

The use of traditional folk remedies is increasing throughout Asia. Chelidonium majus, a popular herbal remedy, is used to treat abdominal pain caused by various gastrointestinal disorders, including gastric ulcer, gastritis, and biliary tract disease, because of its morphine-like effect. We encountered a 62-year-old woman with acute hepatitis, in which C. majus was suspected to be the etiological factor. The patient had taken high dose of C. majus extract for the preceding 60 days. The clinical context and the temporal association between the start of the herbal medicine treatment and her liver injury allowed us to attribute a causative role to C. majus. The diagnosis was confirmed by liver biopsy and the Council for International Organizations of Medical Sciences/Roussel Uclaf Causality Assessment Method (CIOMS/RUCAM) scale. After C. majus was discontinued, the liver function was restored to normal. In conclusion, because the use of phytotherapy is increasing, we wish to raise awareness of the potential adverse effects of C. majus.

Keyword

Drug-induced liver injury; Chelidonium majus; the CIOMS/RUCAM scale; Biopsy

MeSH Terms

Abdominal Pain
Asia
Biliary Tract Diseases
Biopsy
Chelidonium*
Diagnosis
Drug-Induced Liver Injury
Female
Gastritis
Hepatitis*
Herbal Medicine
Humans
Liver
Medicine, Traditional
Middle Aged
Phytotherapy
Stomach Ulcer

Figure

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  Fig. 1 Histologic findings. (A) Histologic findings of liver reveals lobular inflammation showing frequent acidophil necrosis and hepatocyte ballooning (H&E, ×200). (B) Histologic findings of liver reveals mild portal lymphocytic and eosinophilic inflammatory cell infiltration (H&E, ×200).

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  Fig. 2 Hepatic enzymes (AST, ALT) and total bilirubin behavior. AST, aspartate aminotransferase; ALT, alanine aminotransferase.

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