18Cases Of Liver Injury Following Ingestion Of Polygonum Multiflorum

Objectives:Polygonum multiflorum is a popular Chinese herbal medication. In this case series, we report on18otherwise healthy non-viral hepatitis patients who developed liver dysfunction following consumption of Polygonum multiflorum alone.Methods:Concurrent and retrospective analysis was used in this study. The causality of Polygonum multiflorum in liver injury was graded by the Council for International Organizations of Medical Sciences (CIOMS) toxicity scale.Results:From2005to2012,18cases of hepatotoxicity potentially involving Polygonum multiflorum. The median age was42years old (range from18to63). Median time of onset of symptoms was27days (1-120). Prevailing clinical symptoms were fatigue, loss of appetite and jaundice. Sixteen patients had elevated level of total bilirubin (>21mol/l); Liver enzymes elevated markedly in all patients (ALT>40U/L, AST>40U/L, GGT>50U/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,14of18patients were evaluated as being highly probable. All patients responding well to Polygonum multiflorum stop usage, and liver protective-supportive care.Conclusions:Polygonum multiflorum products can be associated with hepatotoxicity in otherwise healthy non-viral hepatitis infected patients, regardless of herbal processing.