Necrotizing hepatitis after taking herbal medication (extracts of kava or of common or lesser celandine)

History and clinical findings: Two unrelated women, aged 39 and 42 years, h ad been admitted (at different times) to hospital because of >>recurrence o f an aetiologically uncertain acute hepatitis<<. Both patients had a histor y of acute hepatitis with GPT concentration of 796 and 755 U/I, respectivel y. Each of them had experienced recurrences of hepatitis, each of them prec eded by taking herbal remedies as alternative medication, containing kava o r common (or lesser) celandine, respectively. In each patient physical exam ination had been unremarkable. Investigations: Maximal values of GPT in the two patients were 422 and 350 U/I, respectively. Viral, autoimmune and metabolic causes of the hepatitis were excluded. In each of them liver biopsy revealed the picture of acute n ecrotizing hepatitis. Diagnosis, treatment and course: As it was supected that the hepatitis was medication-induced, the intake of the mentioned herbal preparations was sto pped. The liver function tests quickly became normal. Conclusion: In view of the rapid response to their withdrawal, a causal con nection between intake of the herbal preparations and the recurrences of ac ute hepatitis is the most likely explanation in both cases.