KUMJ | VOL. 24 | NO. 3 | ISSUE 96 | JULY-SEPTEMBER, 2026

Corticosteroid Responsive Herbal Medicine Induced Severe Cholestatic Liver Injury in an Elderly Female
Dhakal M, Dhakal OP, Dhakal N, Dhakal D

Abstract:
Drug-induced liver injury (DILI) possesses a difficult challenge to clinicians because of its unpredictable course and the varied presentation. Herbal and alternative medicines are notorious to cause severe liver injury. We report a case of a 72-year-old rural lady who developed severe DILI after intake of unknown herbal drugs that she consumed for a month for grade III osteoarthritis. She presented to a tertiary care hospital in Gangtok, Sikkim for generalized pruritus and clay coloured stool. Her clinical examination revealed jaundice and laboratory reports were suggestive of severe hyperbilirubinemia with serum bilirubin of 27 mg/dL. There was mild elevation of liver enzymes (SGOT- 62 IU/L, SGPT- 50 IU/L, ALP- 230 IU/L and GGT-30 IU/L). Her viral markers were negative and autoimmune workup was alsonormal. Abdominal Ultrasound showed only grade I fatty liver without any evidence of portal hypertension. Liver biopsy performed at a higher tertiary centre was suggestive of DILI. Despite intensive supportive management and three sessions of plasmapheresis, bilirubin persisted around 17 mg/dL, and living donor liver transplantation was considered. Oral prednisolone 40 mg/day was initiated as a salvage therapy, leading to dramatic clinical and biochemical recovery with complete normalization of liver function tests within one month. This case highlights the importance of recognizing herbal medication-associated DILI and, a must trial of corticosteroid before considering liver transplantation.
Keyword : Cholestatic hepatitis, Corticosteroids, Drug-induced liver injury, Herbal medicine, Plasmapheresis, Prednisolone