title: [Acute hepatitis due to kava-kava and St John's Wort: an immune-mediated mechanism?].
abstract: METHODS
  In an otherwise healthy 48-year-old female patient, acute hepatitis with transaminase increase (GOT up to 613 U/l, GPT up to 752 U/l), inconspicuous hepatitis serology findings, negative autoantibody status and negative virus serology was observed after a 10-week long intake of kava-kava (1-3 x 200 mg/day) and St John's Wort (1 x 425 mg/day). Biopsy of the liver showed lobular and portal necroinflammatory activity without indication of cirrhosis.
  
  
  METHODS
  Due to these findings with proven T-cell activity (lymphocyte typing, neopterin determination) as well as the aetiopathology, this form of hepatitis with histological characteristics of a nutritive/medicinal toxic origin was classified as induced immunologic idiosyncratic hepatitis, possibly in terms of an antibody-negative autoimmune hepatitis.
  
  
  METHODS
  Discontinuation of the existing medication and simultaneous onset of immunosuppressive combination therapy of cortisone, azathioprine and ursodeoxycholic acid resulted in normalisation of the liver parameters within a period of two months.
  
  
  CONCLUSIONS
  On the one hand, it appears that simultaneous intake of St John's Wort possibly potentiates the toxicity of kavapyrones. On the other hand, an immune-mediated mechanism, induced by kava-kava, cannot be completely excluded in the present case. It must be stressed that in patients with autoimmune hepatitis, precise history of medication intake should also be available.
authors.affiliation: Marienhospital Bottrop, Abteilung für Innere Medizin, Bottrop. eugen.musch@mhb-bottrop.de
authors.forename: E
authors.initials: E
authors.lastname: Musch
authors.forename: A
authors.initials: A
authors.lastname: Chrissafidou
authors.forename: M
authors.initials: M
authors.lastname: Malek
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D004357:Drug Synergism; D005260:Female; D019693:Hepatitis, Autoimmune / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D006801:Humans; D020902:Hypericum / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D020901:Kava / Q000009:adverse effects* / Q000276:immunology; D008099:Liver / Q000473:pathology; D008875:Middle Aged; D028321:Plant Preparations / Q000009:adverse effects* / Q000276:immunology / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D028321:Plant Preparations; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase