title: Eighteen cases of liver injury following ingestion of Polygonum multiflorum.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of the State Key Laboratory for Infection Diseases Diagnosis and Treatment, Zhejiang University, Hangzhou, China; The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China. Electronic address: pudinghuihuid@163.com.
authors.forename: Huihui
authors.initials: H
authors.lastname: Dong
authors.affiliation: Department of Clinical Pharmacy, School of Pharmacy, West Virginia University, Morgantown, WV 26506-9520, USA. Electronic address: dslain@hsc.wvu.edu.
authors.forename: Douglas
authors.initials: D
authors.lastname: Slain
authors.affiliation: Department of the State Key Laboratory for Infection Diseases Diagnosis and Treatment, Zhejiang University, Hangzhou, China; The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China.
authors.forename: Junchi
authors.initials: J
authors.lastname: Cheng
authors.affiliation: Department of the State Key Laboratory for Infection Diseases Diagnosis and Treatment, Zhejiang University, Hangzhou, China; The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China; Health Bureau of Zhejiang Province, Hangzhou, China.
authors.forename: Weihang
authors.initials: W
authors.lastname: Ma
authors.affiliation: Department of the State Key Laboratory for Infection Diseases Diagnosis and Treatment, Zhejiang University, Hangzhou, China; The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China. Electronic address: pudinghuihuid@163.com.
authors.forename: Weifeng
authors.initials: W
authors.lastname: Liang
mesh_terms: D000293:Adolescent; D000328:Adult; D001663:Bilirubin / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D004365:Drugs, Chinese Herbal / Q000506:poisoning*; D004798:Enzymes / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D028502:Polygonum; D055815:Young Adult
chemical_list: D004365:Drugs, Chinese Herbal; D004798:Enzymes; D001663:Bilirubin
keywords: Fo-ti; Hepatotoxicity; Polygonum multiflorum