Eighteen cases of liver injury following ingestion of Polygonum multiflorum

Objectives: Polygonum multiflorum is a popular Chinese herbal medication. In this case series, we report on 18 otherwise healthy non-viral hepatitis patients who developed liver dysfunction following consumption of P. multiflorum alone. Methods: Concurrent and retrospective analysis was used in this study. The causality of P multiflorum in liver injury was graded by the Council for International Organizations of Medical Sciences (CIOMS) toxicity scale. Results: From 2005 to 2012, 18 cases of hepatotoxicity potentially involving P multiflorum. The median age was 42 years old (range from 18 to 63). Median time of onset of symptoms was 27 days (1-120). Prevailing clinical symptoms were fatigue, loss of appetite and jaundice. Sixteen patients had elevated level of total bilirubin (>21 mol/L); liver enzymes elevated markedly in all patients (ALT > 40 U/L, AST > 40 U/L, GGT > 50 U/L), except for alkaline phosphatase which elevated only in nine patients. Based on the liver enzyme pattern, the type of liver injuries were hepatocellular according to CIOMS. In terms of causality, 14 of 18 patients were evaluated as being highly probable. All patients were responding well to P multiflorum stoppage, and liver protective-supportive care. Conclusions: P multiflorum products can be associated with hepatotoxicity in otherwise healthy non-viral hepatitis infected patients, regardless of herbal processing. (C) 2013 Elsevier Ltd. All rights reserved.