PMC6798169_01
Artemisia annua powder tea.
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F1
The patient provided us with the container, which had originally contained 50 g of a dark green powder (Figure 1).
Histology of the the first (A,B) and second (C,D) liver biopsy. (A) Low power view of hepatic biopsy showing a portal lymphocytic infiltrate [Hematoxylin and eosin (HE), 10x]. (B) Liver parenchyma with intracellular bilirubinostasis (HE, 20x). (C) Low power view of hepatic biopsy without significant portal inflammation (HE, 10x). (D) Liver parenchyma with significant intracellular and extracellular (arrow) bilirubinostasis (HE, 20x).
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F2
Neither fibrosis nor parasitic material was seen (Figures 2A,B). The second biopsy showed a severe intracytoplasmatic as well as intracanalicular bilirubinostasis, with only minimal inflammation compared to the first biopsy (Figures 2C,D).
Course of bilirubin and liver enzymes over time.
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F3
Corticosteroid treatment was discontinued, ursodeoxycholic acid was continued until resolution of jaundice and normalization of bilirubin (15.3 mumol/l) (Figure 3) and relevant decrease of bile acids (19.5 mumol/l) which occurred three months after the disease's onset.