title: A Serendipitous Find: A Case of Cholangiocarcinoma Identified Incidentally After Acute Liver Injury Due to Cascara sagrada Ingestion.
abstract: The use of anthranoid laxatives such as Cascara sagrada can, in rare instances, produce a hepatitis that resolves with discontinuation of the offending supplement. However, the clinical presentation of abdominal pain, jaundice, clay-colored stools, and darkening urine can mimic the presentation of a variety of hepatobiliary illnesses, including cholangiocarcinoma. This case report describes a local patient diagnosed with an extrahepatic cholangiocarcinoma following workup for an acute hepatitis due to ingestion of large quantities of Cascara sagrada.
authors.affiliation: John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Nakasone
authors.affiliation: John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI.
authors.forename: Jinichi
authors.initials: J
authors.lastname: Tokeshi
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis*; D017734:Bile Ducts, Extrahepatic; D002400:Cathartics / Q000009:adverse effects; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis* / Q000209:etiology; D018281:Cholangiocarcinoma / Q000175:diagnosis*; D003248:Constipation / Q000188:drug therapy; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008517:Phytotherapy / Q000009:adverse effects*; D028321:Plant Preparations / Q000009:adverse effects; D031955:Rhamnus / Q000009:adverse effects*
chemical_list: D002400:Cathartics; D028321:Plant Preparations
keywords: Drug-induced liver injury; cascara; cholangiocarcinoma; cholestasis; jaundice