title: Drug-Induced Liver Injury: Twenty Five Cases of Acute Hepatitis Following Ingestion of Polygonum multiflorum Thunb.
abstract: OBJECTIVE
  Complementary medicines, including herbal preparations and nutritional supplements, are widely used without prescriptions. As a result, there has been growing interest in the risk of hepatotoxicity with these agents. It is difficult to determine causal relationships between these herbal preparations and hepatotoxicity. We report on 25 patients diagnosed with toxic hepatitis following ingestion of Polygonum multiflorum Thunb.
  
  
  METHODS
  Twenty-five patients (median age, 48 years [24 to 65 years]; M:F=18:7) with suspected P. multiflorum Thunb-induced liver injury were admitted to our hospital between 2007 and 2009. We analyzed clinical and histological data, including the types and the duration of P. multiflorum Thunb intake and the duration of hospital care. We also determined the type of liver injury using the R ratio (serum activity of ALT/serum activity of ALP).
  
  
  RESULTS
  The types of complementary medicine used included tea (n=16), liquor (n=5), tea and liquor (n=2), powder (n=1), and honeyed pudding (n=1). The most common presenting sign was jaundice (76%), and 18 patients (72%) had evidence of hepatocellular liver injury. Histological findings were consistent with acute hepatitis in all cases (n=10) for which liver biopsy was performed. Twenty-three patients (91.6%) recovered with conservative management, 1 patient (4%) had a liver transplant, and 1 patient (4%) died of hepatic failure.
  
  
  CONCLUSIONS
  In our cases, we found that P. multiflorum Thunb could be hepatotoxic and could lead to severe drug-induced liver injury, and even death.
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Kyoung Ah
authors.initials: KA
authors.lastname: Jung
authors.forename: Hyun Ju
authors.initials: HJ
authors.lastname: Min
authors.forename: Seung Suk
authors.initials: SS
authors.lastname: Yoo
authors.forename: Hong Jun
authors.initials: HJ
authors.lastname: Kim
authors.forename: Su Nyoung
authors.initials: SN
authors.lastname: Choi
authors.forename: Chang Yoon
authors.initials: CY
authors.lastname: Ha
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Tae Hyo
authors.initials: TH
authors.lastname: Kim
authors.forename: Woon Tae
authors.initials: WT
authors.lastname: Jung
authors.forename: Ok Jae
authors.initials: OJ
authors.lastname: Lee
authors.forename: Jong Sil
authors.initials: JS
authors.lastname: Lee
authors.forename: Sang Goon
authors.initials: SG
authors.lastname: Shim