“…100 Comfrey-induced injury involves fibrous obliteration and destruction of hepatic veins, leading to cirrhosis. 101,102 However, hepatotoxicity, including SOS, acute or chronic hepatitis, cholestasis, hepatic necrosis or fibrosis, cirrhosis, and outright liver failure, can occur with a much broader array of herbal products, 103 owing to variability in what plant components have been used, storage conditions for the plant products, mislabeling or misidentification of the plant, and outright contaminations, 104,105 Even Echinacea, widely touted as being completely free of toxicities, is known to contain pyrrolizidine alkaloids and may induce hepatotoxicity. 106 Clinical presentation of hepatotoxicity arising in the setting of herbal product use is non-specific, involving fatigue, loss of appetite, and potentially jaundice.…”