Subacute cholestatic hepatitis likely related to the use of senna for chronic constipation.
We report a case of senna-induced cholestatic hepatitis which was not diagnosed at presentation. A 77 year old male was referred with abdominal pain, jaundice and elevated transaminase levels. A diagnosis of extrahepatic cholestasis was first suspected, due to the observation of a duodenal diverticulum and dilated proximal choledocus. However, the sphincterotomy did not improve cholestasis. At further evaluation, HBsAg was positive but serological work up was compatible with a healthy-carrier status. Further interrogation of the patient revealed a history of chronic senna intake to treat a chronic constipation. Liver biopsy showed bridging hepatocellular necrosis as well as canalicular cholestasis. Drug withdrawal resulted in a slow and progressive reduction in bilirubin levels and liver enzymes. In this case senna was likely the cause of a subacute cholestatic hepatitis exemplifying again the potential role of herbal related liver injury.
Sonmez
Alper
A
Gulhane School of Medicine, Department of Internal Medicine, Ankara, Turkey. alpersonmez@yahoo.com
Yilmaz
M Ilker
MI
Mas
Refik
R
Ozcan
Ayhan
A
Celasun
Bülent
B
Dogru
Teoman
T
Taslipinar
Abdullah
A
Kocar
I Hakki
IH
D000368:Aged; D001706:Biopsy; D002400:Cathartics / Q000009:adverse effects* / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000473:pathology; D002780:Cholestasis, Intrahepatic / Q000139:chemically induced* / Q000150:complications / Q000473:pathology; D002908:Chronic Disease; D003248:Constipation / Q000188:drug therapy*; D006801:Humans; D008297:Male; D012676:Senna Extract / Q000009:adverse effects* / Q000627:therapeutic use
D002400:Cathartics; D012676:Senna Extract