1: Dtsch Med Wochenschr  2001 Sep 7;126(36):970-2

[Fulminant liver failure after administration of the herbal
antidepressant
Kava-Kava]

[Article in German]

Kraft M, Spahn TW, Menzel J, Senninger N, Dietl KH, Herbst H, Domschke
W, Lerch
MM.

Medizinische Klinik und Poliklinik B, Universitat Munster, Germany.

HISTORY AND CLINICAL FINDINGS: A 60 year-old woman was admitted to
hospital
because of jaundice, fatigue, weight loss over several months and
icteric skin.
Because of progressive liver failure, concomitant renal failure and
progressive
encephalopathy she was transferred to an intensive care unit.
INVESTIGATIONS:
Biochemical tests revealed acute liver failure with high levels of total
and
conjugated bilirubin (30 mg/dl) as well as aspartate aminotransferase
(921 IU/l)
and alanine aminotransferase (1350 IU/l) concentrations. Prothrombin
time was
less than 10 %. Serological tests could rule out viral hepatitis,
metabolic or
autoimmune causes of liver failure. On abdominal computed tomography and
ultrasonography no pathological changes were detected. Above all portal
vein
thrombosis, ascites, focal lesions of the liver and extrahepatic
cholestasis
could be excluded. Liver histology showed extensive hepatocellular
necrosis with
intrahepatic cholestasis. TREATMENT AND CLINICAL COURSE: The patient's
physical
condition deteriorated. She had to be intubated because of respiratory
insufficiency and encephalopathy stage IV. Because of progressive liver
failure
under conservative treatment the patient received an orthotopic liver
transplant
11 days after admission. CONCLUSIONS: The exclusion of other causes and
the
histological diagnosis made Kava-Kava as the cause of acute liver
failure most
likely. This is the 18th case of Kava-Kava induced liver failure
reported to the
European regulatory authorities.

PMID: 11544547 [PubMed - indexed for MEDLINE]

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1: Dtsch Med Wochenschr  1998 Nov 20;123(47):1410-4

[Necrotizing hepatitis after taking herbal remedies]

[Article in German]

Strahl S, Ehret V, Dahm HH, Maier KP.

Medizinische Klinik, Fachbereich Gastroenterologie, Stadtische Kliniken
Esslingen am Neckar.

HISTORY AND CLINICAL FINDINGS: Two unrelated women, aged 39 and 42
years, had
been admitted (at different times) to hospital because of "recurrence of
an
aetiologically uncertain acute hepatitis". Both patients had a history
of acute
hepatitis with GPT concentration of 796 and 755 U/l, respectively. Each
of them
had experienced recurrences of hepatitis, each of them preceded by
taking herbal
remedies as alternative medication, containing kava or common (or
lesser)
celandine, respectively. In each patient physical examination had been
unremarkable. INVESTIGATIONS: Maximal values of GPT in the two patients
were 422
and 350 U/l, respectively. Viral, autoimmune and metabolic causes of the
hepatitis were excluded. In each of them liver biopsy revealed the
picture of
acute necrotizing hepatitis. DIAGNOSIS, TREATMENT AND COURSE: As it was
suspected that the hepatitis was medication-induced, the intake of the
mentioned
herbal preparations was stopped. The liver function tests quickly became
normal.
CONCLUSION: In view of the rapid response to their withdrawal, a causal
connection between intake of the herbal preparations and the recurrences
of
acute hepatitis is the most likely explanation in both cases.

PMID: 9856112 [PubMed - indexed for MEDLINE]