Drug-induced Liver Injury Due to a Horse Chestnut Dietary Supplement.

Drug-induced liver injury (DILI) is the most common cause of acute liver failure in the Western world. In recent years, natural herbal and dietary supplements have become widely available to the general public and have increased in popularity. Reports of idiosyncratic liver injury caused by such supplements have also increased over the last decade. Horse chestnut is a herb used in dietary supplements primarily for complications of venous insufficiency. Clinically significant acute liver injury has been very rarely associated with its use. We present the case of a 70-year-old man with idiosyncratic horse chestnut-induced liver injury. LEARNING POINTS: Idiosyncratic drug-induced liver injury is one of the most challenging liver disorders.Herbs and natural dietary supplements are widely popular and should be considered when evaluating liver injury of unknown origin.Patients may not consider herbs and supplements to be drugs with the potential to cause adverse effects, requiring a more careful medication history. © EFIM 2021.