Drug-induced Liver Injury Attributed to Traditional Herbal Medication: A Case Report with Histopathological and Clinical Correlations

Drug-induced liver injury (DILI) is a diagnostic dilemma, often mimicking other hepatic disorders and posing a significant clinical challenge. While pharmaceuticals are well-documented culprits, herbal and traditional medications, widely perceived as harmless, increasingly contribute to hepatotoxicity, particularly in the eastern parts of the world, where their use is prevalent yet unregulated. We present the case of a 58-year-old female with a 10-day history of jaundice and new-onset abdominal discomfort, with no identifiable risk factors, the only notable detail being her intake of Ayurvedic herbal preparations for joint pains, 3 months before the onset of symptoms. Physical examination revealed icterus, while laboratory work showed hyperbilirubinemia and elevated liver enzymes, which was suggestive of hepatic dysfunction with a cholestatic pattern (R ratio: 1.6). Extensive evaluation for viral, autoimmune, and metabolic causes was negative. Liver biopsy revealed focal hepatocellular necrosis, eosinophilic infiltration, and microvesicular steatosis, which are features of DILI. Applying the Roussel Uclaf Causality Assessment Method (RUCAM), the patient scored 7, indicating a probable link to the herbal medication. Supportive care was initiated, and liver function improved steadily, allowing for a safe discharge within a week. This case highlights the potential hepatotoxicity of certain alternative and traditional herbal medications and drugs, as these preparations may contain undisclosed or poorly regulated ingredients. Hence, thorough history-taking, awareness, and clinical suspicion coupled with structured causality tools like RUCAM can aid in the early diagnosis and timely intervention of DILI.