Table 1.
Biochemical, Serological and Histopathological Profile of Six Patients Consuming Tinospora Cordifolia.
| Patient 1 | Patient 2 | Patient 3 | Patient 4 | Patient 5 | Patient 6 | ||
|---|---|---|---|---|---|---|---|
| Age/sex | 40/M | 54/F | 38/M | 62/F | 56/F | 56/F | |
| Laboratory parameters | Hb (g/dl) | 13.7 | 10.9 | 9 | 12.4 | 11.5 | 11.8 |
| TLC (cells/cmm) | 16000 | 6200 | 9200 | 8400 | 8550 | 6690 | |
| Platelets (cells/cmm) | 388000 | 187000 | 371000 | 103000 | 241000 | 140000 | |
| Presentation total bilirubin (direct bilirubin) (mg/dl) | 7.9 (6.7) | 15.3 (10.9) | 7.4 (3.9) | 9.1 (5.7) | 12.2 (7.5) | 9.13 (4.41) | |
| Peak total bilirubin (direct bilirubin) (mg/dl) | 45.1 (25) | 24.9 (21) | 20 (10.7) | 15.1 (12.5) | 12.2 (7.5) | 9.1 (4.4) | |
| On presentation AST (IU/L) | 1773 | 1195 | 760 | 369 | 1099 | 347 | |
| Peak AST (IU/L) | 1773 | 1195 | 1504 | 2222 | 1099 | 455 | |
| On presentation ALT (IU/L) | 2894 | 768 | 560 | 202 | 256 | 207 | |
| Peak ALT (IU/L) | 3114 | 768 | 1482 | 855 | 256 | 472 | |
| Time to normalisation of LFT (in days) | 95 | 164 | 78 | 111 | 38 | 53 | |
| Autoimmune profile (pre/post)a | ANA | Negative/- | 1:100/Negative | 1:100/-ve | 1:320/1:320 | Negative/- | Negative/- |
| Anti-SMA | Negative/- | Negative/- | – | Positive/Negative | Negative/- | Weakly positive/Negative | |
| Serum IgG (700–1600 mg/dl) | Normal/- | Normal/- | Normal/- | – | 2570/1721 | 2045/1680 | |
| Revised AIH scoreb(pre/post when steroids given) | 12 | 19/21 | 15 | 19/22 | 18/21 | 18 | |
| Liver biopsy | Interface hepatitis | ++ | +++ | + | +++ | ++ | + |
| Lymphocytes | ++ | ++ | ++ | ++ | ++ | ++ | |
| Eosinophils | + | ++ | +++ | +++ | ++ | ++ | |
| Plasma cells | + | + | + | ++ | ++ | ++ | |
| Neutrophils | – | ++ | – | +++ | – | – | |
| Pattern | Hepatocellular | Hepatocellular + Cholestatic | Hepatocellular | Hepatocellular | Hepatocellular | Hepatocellular | |
| Updated RUCAM score refc c(without rechallenge) | 4 | 5 | 4 | 7 | 7 | 4 | |
Abbreviations - M: Male, F: Female, Hb: Haemoglobin, TLC: Total leucocyte count, AST: Aspartate aminotransferase, ALT: Alanine aminotransferase, LFT: Liver function tests, ANA: Anti-nuclear antibody, Anti-SMA: Anti-smooth muscle antibody, IgG: Immunoglobulin G, AIH: Autoimmune hepatitis.
+++: Prominent/Abundant ++: Moderate +: Mild/Occasional -: Not seen/done.
Pre-stopping the drug and post-stopping the drug, - implies not done as previous ANA/ASMA were negative or IgG was normal.
Revised AIH score: Pre-treatment: Definite AIH >15 Probable AIH l0-15 Post-treatment: Definite AIH >17 12 Probable AIH 12–17.
Updated RUCAM score and resulting causality grading: ≤0, excluded; 1–2, unlikely; 3–5, possible; 6–8, probable; and ≥9 highly probable.