Kunal K Dalal, MD, Department of Medicine, Cooper Medical School of Rowan University, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103, United States. kunald89@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Nov 8, 2017; 9(31): 1205-1209 Published online Nov 8, 2017. doi: 10.4254/wjh.v9.i31.1205
Ayurvedic drug induced liver injury
Kunal K Dalal, Thomas Holdbrook, Steven R Peikin
Kunal K Dalal, Department of Medicine, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, NJ 08103, United States
Thomas Holdbrook, Department of Pathology, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, NJ 08103, United States
Steven R Peikin, Division of Gastroenterology and Liver Disease, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, NJ 08103, United States
Author contributions: All authors took care of the patient medically; Dalal KK analyzed and drafted the report; Holdbrook T and Peikin SR made critical appraisals of the report.
Institutional review board statement: Cooper Health System Institutional Review Board does not require IRB review for Case Reports less than 5 patients.
Informed consent statement: Informed consent was acquired from the patient.
Conflict-of-interest statement: None of the authors have any financial disclosures or conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kunal K Dalal, MD, Department of Medicine, Cooper Medical School of Rowan University, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103, United States. kunald89@gmail.com
Telephone: +1-856-3422000 Fax: +1-844-5116895
Received: May 3, 2017 Peer-review started: May 4, 2017 First decision: June 15, 2017 Revised: June 28, 2017 Accepted: August 3, 2017 Article in press: August 3, 2017 Published online: November 8, 2017
Abstract
Drug induced liver injury is responsible for 50% of acute liver failure in developed countries. Ayurvedic and homeopathic medicine have been linked to liver injury. This case describes the first documented case of Punarnava mandur and Kanchnar guggulu causing drug induced liver injury. Drug induced liver injury may be difficult to diagnosis, but use of multi-modalities tools including the ACG algorithms, causative assessment scales, histological findings, and imaging, is recommended. Advanced imaging, such as magnetic resonance cholangiopancreatography, may possibly have a greater role than previously reported in literature.
Core tip: Drug induced liver injury is difficult to diagnose. Certain ayurvedic medications are commonly used without full knowledge of their side effects. This article not only represents the first documented case report of drug induced liver injury secondary to Punarnava mandur and Kanchnar guggulu, but it also demonstrates the possible role for advanced imaging modalities.
