title: Drug- and herb-induced liver injury: a case series from a single center.
abstract: OBJECTIVE
  Drug-induced liver injury (DILI) is common worldwide and has a potentially fatal outcome. It accounts for more than half of the cases of acute liver failure in the United States. Herb-induced liver injury (HILI) is a less documented condition but a growing problem. We present here the clinical characteristics and outcome of patients with drug- and herb-induced liver injury from our center.
  
  
  METHODS
  In this 4-year retrospective study, 82 patients in whom there was a causal or highly probable relationship between herbal medicine or drug use and liver disease are presented.
  
  
  RESULTS
  The mean age of patients was 43.1±14.8 years; sexual distribution was 53 females and 29 males. The major cause of hepatotoxicity was drugs (87.8%), with herbal medicine accounting for 12.2%. The leading causative agents were nonsteroidal anti-inflammatory drugs (NSAIDs) (23.1%), followed by antibiotics (19.5%). The pattern of hepatotoxicity was hepatocellular in 35 patients (42.6%), mixed in 28 (34.1%), and cholestatic in 19 patients (23.1%). Teucrium polium (known popularly as felty germander), which is a traditionally used herbal medicine of the Labiatae family in our region, was the most common cause of herb-induced liver injury and responsible in 7 of 10 herbal hepatotoxic cases. Acute liver failure developed in 3 patients (two patients related with flurbiprofen and diclofenac and one patient due to an isoniazid-rifampicin combination).
  
  
  CONCLUSIONS
  Antibiotics and NSAIDs were the most common etiologic agents for drug-induced liver injury. Surprisingly, herbs follow these groups of drugs and must be questioned more carefully.
authors.affiliation: Department of Gastroenterology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey.
authors.forename: Muhammed Said
authors.initials: MS
authors.lastname: Dağ
authors.forename: Musa
authors.initials: M
authors.lastname: Aydınlı
authors.forename: Zeynel Abidin
authors.initials: ZA
authors.lastname: Oztürk
authors.forename: Ibrahim Halil
authors.initials: IH
authors.lastname: Türkbeyler
authors.forename: Irfan
authors.initials: I
authors.lastname: Koruk
authors.forename: Muhammed Cemil
authors.initials: MC
authors.lastname: Savaş
authors.forename: Mehmet
authors.initials: M
authors.lastname: Koruk
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Kadayıfçı
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D028321:Plant Preparations / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014421:Turkey
chemical_list: D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D028321:Plant Preparations