title: Hepatitis from Greater celandine (Chelidonium majus L.): review of literature and report of a new case.
abstract: BACKGROUND
  Folk medicine is a rich source of useful therapeutic tools. Nevertheless, use of medicinal plants can have unwanted, negative effects. By means of the description of an adverse reaction to a herbal remedy, we highlight the need for better efficacy-toxicity studies on these products.
  
  
  OBJECTIVE
  To report a case of possible Chelidonium majus L. (Greater celandine)-induced hepatitis and evaluate the past published cases.
  
  
  METHODS
  We outlined the main features of hepatitis associated with use of Chelidonium majus by providing a review of cases reported and analysing in detail a new one.
  
  
  RESULTS
  Several cases of acute hepatitis related to Greater celandine consumption were found in the literature. The assessment for causality using Naranjo probability scale showed a probable relationship between the liver injury and the consumption of Chelidonium majus in the case we described.
  
  
  CONCLUSIONS
  Our case, along with the other ones reported in the literature, increases the concern about the safety of oral use of Chelidonium majus. Plants used in traditional medicine are not necessarily harmless. Customers and prescribers should be aware of this, especially when a herbal drug is used with therapeutic purposes in absence of reliable studies of clinical efficacy and benefit-risk assessment.
authors.affiliation: Niguarda Ca' Granda Hospital, Poison Control Centre, Piazza Ospedale Maggiore, 3, 20162 Milan, Italy. paola.moro@ospedaleniguarda.it
authors.forename: Paola A
authors.initials: PA
authors.lastname: Moro
authors.forename: Federica
authors.initials: F
authors.lastname: Cassetti
authors.forename: Gianni
authors.initials: G
authors.lastname: Giugliano
authors.forename: Maria T
authors.initials: MT
authors.lastname: Falce
authors.forename: Gabriela
authors.initials: G
authors.lastname: Mazzanti
authors.forename: Francesca
authors.initials: F
authors.lastname: Menniti-Ippolito
authors.forename: Roberto
authors.initials: R
authors.lastname: Raschetti
authors.forename: Carmela
authors.initials: C
authors.lastname: Santuccio
mesh_terms: D000284:Administration, Oral; D000368:Aged; D028281:Chelidonium / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D006356:Heartburn / Q000188:drug therapy; D006801:Humans; D008099:Liver / Q000187:drug effects; D008297:Male; D028321:Plant Preparations / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D028321:Plant Preparations