Table 6.
Similarities and differences among current case studies and published cases of black cohosh hepatotoxicity.
| Case reports | Whiting Case 1* | Whiting Case 2* | Lontos* | Levitsky* | Cohen* | Lynch* | Chow | Nisbet | Current study Case 1## | Current study Case 2 |
|---|---|---|---|---|---|---|---|---|---|---|
| Age/gender | 47F | 43F | 52F | 50F | 57F | 54F | 51F | 50F | 42F | 53F |
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| Botanical dietary contents | Black cohosh | Black cohosh, skullcap#, Valerean, Passionflower | Black cohosh, ground ivy#, golden seal, Gingko, oat seed | Black cohosh | Black cohosh | Black cohosh | Black cohosh | Black cohosh | Black cohosh | Black cohosh, soy |
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| Other drugs | Levothyroxine | Levothyroxine | Levothyroxine | Dicyclomine | ||||||
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| Serologies indicating presence of other liver diseases | Absent | Absent | Absent | Absent | Absent | |||||
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| Lab data indicating presence of other liver diseases | Absent | Absent | Absent | Absent | Absent | |||||
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| Presenting symptom | Jaundice | ALF | ALF | ALF | Jaundice | Acute hepatitis | Acute hepatitis | RUQ pain | ||
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| Main liver biopsy finding | Acute hepatitis | Acute hepatitis | Massive liver necrosis | Centrilobular necrosis | Centrilobular necrosis | |||||
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| Lobular infiltrate | Mixed + plasma cells | Mononuclear infiltrate | Plasma cytic infiltrate | Lymphop-lasmacytic infiltrate | ||||||
| Other lobular findings | Necrosis | Bridging necrosis | Preserved bile ducts, collapsed parenchyma | Lobular disarray | Lobular disarray | |||||
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| Therapy | Prednisone | Immuno-therapy | Prednisone | Prednisone & azathioprine | Prednisone | |||||
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| Intervention | OLT | OLT | OLT | OLT | Withdrawal of black cohosh | Withdrawal of black cohosh | Withdrawal of black cohosh | |||
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| Outcome | Recovery | LF s/p d/c black cohosh | Recovery | Recovery | LF death hemorrhage | Recovery | Recovery | Recovery | Recovery | |
| AIH like histology | Present | Present | Present | Present | Present | |||||
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| Serological marker for AIH | Absent | Absent | Absent | Absent | Absent | Absent | ||||
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| Issues disputing validity of black cohosh hepatoxicity | Drug use for only 6 days | Multi-drug product | Multi-drug product | Multi drug use Ethanol, NSAID & cyclovir | 7 day use; maybe AIH | 2 weeks exposure; cholelithiasis | Maybe AIH | |||