Lesser celandine （pilewort） induced acute toxic liver injury：The first case report worldwide
摘要
Lesser celandine, also known as Ranunculus ficaria , isa herbaceous perennial plant that commonly utilizespiles and is taken either internally or used externally.The causality assessment of several reports providedevidence for the existence of Greater Celandinehepatotoxicity. However, there hasn＇t been any casereport published thus far, about lesser celandineinduced liver injury. Here, we present a case of36-year-old woman admitted to the hospital with acutehepatitis and jaundice on her sclera with no historyof drug abuse or alcohol consumption. However, thepatient had a recent history of lesser celandine extractconsumption for hemorrhoids, for about 10 d, prior tothe admission. Viral hepatitis, autoimmune hepatitis,and drug induced toxic hepatitis were ruled out byfurther imaging studies and laboratory analysis. Usingthe Council for International Organizations of MedicalSciences scale, the type of liver injury was assumedas hepatocellular and was scored as 7 which showsprobable causality. Immediate discontinuation of lessercelandine extract resulted in rapid decrease of theelevated enzymes. Herbs have been reported to causeliver injury and therefore should be suspected in thecase of acute hepatitis with an unknown etiology. Thiscase is important to be the first to explain hepatotoxicitycaused by lesser celandine. Physicians should considerlesser celandine as a causative agent for hepatotoxicity.