Acute liver failure secondary to Ayurvedic Herbal medication in a child: a case report

Ayurvedic and Herbal medicine induced liver injury is rarely reported in children. The injury can range from mild asymptomatic elevation of liver enzymes to severe presentation with acute liver failure leading to death. The diagnosis is by exclusion and relies on accurate history and clinical examination supported by laboratory investigations.  Various causality assessments such as council for international organizations of medical sciences (CIOMS) and Roussel Uclaf Causality Assessment Method (RUCAM) have been reported to be useful in reaching the diagnosis of Herbal Induced Liver Injury (HILI). However, these scales have not been validated specifically for pediatric age group. In this report, we present a case of a child who was presented to our department with acute liver failure after taking unlabeled ayurvedic medicine for jaundice and loss of appetite. The child was examined for age specific causes of hepatic injury and acute liver failure and he was managed conservatively. Despite extensive search, we did not find any etiology and suspected herbal medicine induced hepatic injury. She recovered completely after stopping the offending medicines. This case highlights the paradoxical hepatotoxic effect of such medications, widely considered safe and natural by the masses. Pediatric hepatologists and general practitioners should be well aware about such adverse effects of herbal medications when encountered with patients with abnormal liver functions. The health authorities need to establish strict quality check and regulations both in the production and sale of ayurvedic medications.