title: Subacute cholestatic hepatitis likely related to the use of senna for chronic constipation.
abstract: 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.
authors.affiliation: Gulhane School of Medicine, Department of Internal Medicine, Ankara, Turkey. alpersonmez@yahoo.com
authors.forename: Alper
authors.initials: A
authors.lastname: Sonmez
authors.forename: M Ilker
authors.initials: MI
authors.lastname: Yilmaz
authors.forename: Refik
authors.initials: R
authors.lastname: Mas
authors.forename: Ayhan
authors.initials: A
authors.lastname: Ozcan
authors.forename: Bülent
authors.initials: B
authors.lastname: Celasun
authors.forename: Teoman
authors.initials: T
authors.lastname: Dogru
authors.forename: Abdullah
authors.initials: A
authors.lastname: Taslipinar
authors.forename: I Hakki
authors.initials: IH
authors.lastname: Kocar
mesh_terms: 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
chemical_list: D002400:Cathartics; D012676:Senna Extract