{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T23:18:39Z","timestamp":1788304719225,"version":"build-2803163510"},"reference-count":26,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,4,4]]},"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:p>Drug-induced liver injury is an uncommon yet fatal cause of liver injury. Black cohosh is a herbal supplement that is derived from <jats:italic>Actaea racemosa<\/jats:italic>. It has been used for vasomotor symptoms in postmenopausal women, but it can cause liver injury. A 50-year-old Afro-American woman presented with a 2-month history of malaise, itching and severe jaundice. The labs showed elevation of bilirubin and alkaline phosphatase. The patient had a history of black cohosh use for postmenopausal symptoms before she developed her current symptoms. The extensive workup for infective and autoimmune pathology was negative. Black cohosh was discontinued. The patient improved clinically, and her liver enzymes normalised 6 months after the discontinuation of black cohosh. This report emphasises the need to recognise black cohosh as a potential hepatotoxic agent and to monitor the liver enzymes for a patient on black cohosh.<\/jats:p>","DOI":"10.1136\/bcr-2020-240408","type":"journal-article","created":{"date-parts":[[2021,5,7]],"date-time":"2021-05-07T11:47:32Z","timestamp":1620388052000},"page":"e240408","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Case of cholestatic drug-induced liver injury (DILI) associated with black cohosh"],"prefix":"10.1136","volume":"14","author":[{"given":"Himmat Singh","family":"Brar","sequence":"first","affiliation":[{"name":"Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachana","family":"Marathi","sequence":"additional","affiliation":[{"name":"Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,5,7]]},"reference":[{"key":"2025082708484639000_14.5.e240408.1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.02.006"},{"key":"2025082708484639000_14.5.e240408.2","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.319.7224.1541","article-title":"Accuracy of hepatic adverse drug reaction reporting in one English health region","volume":"319","author":"Aithal","year":"1999","journal-title":"BMJ"},{"key":"2025082708484639000_14.5.e240408.3","first-page":"715","article-title":"[An analysis of 66 cases of drug-induced liver injury]","volume":"18","author":"Wang","year":"2010","journal-title":"Zhonghua Gan Zang Bing Za Zhi"},{"key":"2025082708484639000_14.5.e240408.4","first-page":"bcr2013009325","article-title":"Subacute liver failure secondary to black cohosh leading to liver transplantation","volume":"2013","author":"Lim","year":"2013","journal-title":"Case Rep Child Meml Hosp Chic"},{"key":"2025082708484639000_14.5.e240408.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.1992.tb00562.x"},{"key":"2025082708484639000_14.5.e240408.6","doi-asserted-by":"publisher","DOI":"10.3109\/00365528209182041"},{"key":"2025082708484639000_14.5.e240408.7","first-page":"112","article-title":"A focus on epidemiology of drug-induced liver injury: analysis of a prospective cohort","volume":"21","author":"Licata","year":"2017","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"2025082708484639000_14.5.e240408.8","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1240002"},{"key":"2025082708484639000_14.5.e240408.9","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21095"},{"key":"2025082708484639000_14.5.e240408.10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra052270"},{"key":"2025082708484639000_14.5.e240408.11","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1240002"},{"key":"2025082708484639000_14.5.e240408.12","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20948"},{"key":"2025082708484639000_14.5.e240408.13","doi-asserted-by":"publisher","DOI":"10.2165\/00002018-200730040-00001"},{"key":"2025082708484639000_14.5.e240408.14","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1073117"},{"key":"2025082708484639000_14.5.e240408.15","unstructured":"U.S. National Library of Medicine . 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