{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:23:34Z","timestamp":1789579414393,"version":"build-2803163510"},"reference-count":7,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of the Royal College of Physicians of Edinburgh"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:p>A 39-year-old female presented with a one-week history of jaundice and nausea after taking an over-the-counter herbal supplement containing ashwagandha root extract. Initial investigations revealed a hepatocellular pattern of liver enzyme abnormality with jaundice. Investigations, including viral serology, liver specific autoantibodies and an ultrasound scan of the abdomen, were unremarkable. Liver biopsy showed an acute cholestatic hepatitis with confluent necrosis but no features of chronicity. These histopathological findings differ to that of a previously reported case. Review of recent literature revealed that some clinical features and the time course of liver injury were similar to previous reports of ashwagandha drug-induced liver injury (DILI). The patient received treatment with ursodeoxycholic acid. We compare this case to previous reported cases of ashwagandha DILI and discuss the biochemical and histopathological features of ashwagandha DILI, therapeutic strategies and the importance of recognising herbal supplements as a possible cause of DILI.<\/jats:p>","DOI":"10.4997\/jrcpe.2021.409","type":"journal-article","created":{"date-parts":[[2021,12,12]],"date-time":"2021-12-12T12:52:37Z","timestamp":1639313557000},"page":"363-366","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":27,"title":["Drug-Induced Hepatocellular Injury Due to Herbal Supplement Ashwagandha"],"prefix":"10.1177","volume":"51","author":[{"given":"Peter J","family":"Ireland","sequence":"first","affiliation":[{"name":"Internal Medicine Trainee, Liver Unit, Freeman Hospital, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Hardy","sequence":"additional","affiliation":[{"name":"Specialist Registrar in Hepatology, Liver Unit, Freeman Hospital, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alastair D","family":"Burt","sequence":"additional","affiliation":[{"name":"Professor of Precision and Molecular Pathology and Honorary Consultant Histopathologist, Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mhairi C","family":"Donnelly","sequence":"additional","affiliation":[{"name":"Consultant Hepatologist, Liver Unit, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,12,1]]},"reference":[{"key":"bibr1-jrcpe.2021.409","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27317"},{"key":"bibr2-jrcpe.2021.409","doi-asserted-by":"publisher","DOI":"10.1080\/19390211.2017.1284970"},{"key":"bibr3-jrcpe.2021.409","unstructured":"LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases. 2012\u2013. Ashwagandha. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK548536\/"},{"key":"bibr4-jrcpe.2021.409","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14393"},{"key":"bibr5-jrcpe.2021.409","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2015.03.006"},{"key":"bibr6-jrcpe.2021.409","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(01)00092-7"},{"key":"bibr7-jrcpe.2021.409","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.05.013"}],"container-title":["Journal of the Royal College of Physicians of Edinburgh"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4997\/jrcpe.2021.409","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4997\/jrcpe.2021.409","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T06:35:35Z","timestamp":1777617335000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.4997\/jrcpe.2021.409"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":7,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["10.4997\/jrcpe.2021.409"],"URL":"https:\/\/doi.org\/10.4997\/jrcpe.2021.409","relation":{},"ISSN":["1478-2715","2042-8189"],"issn-type":[{"value":"1478-2715","type":"print"},{"value":"2042-8189","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]}}}