Shao YL, Ma CM, Wu JM, Guo FC, Zhang SC. Concurrent severe hepatotoxicity and agranulocytosis induced by Polygonum multiflorum: A case report. World J Clin Cases 2022; 10(27): 9921-9928 [PMID: 36186172 DOI: 10.12998/wjcc.v10.i27.9921]
Corresponding Author of This Article
You-Lin Shao, MD, Chief Physician, Department of Hepatology, Changzhou Third People's Hospital, No. 300 North Lanling Road, Changzhou 213001, Jiangsu Province, China. syl84289@aliyun.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
You-Lin Shao, Chun-Ming Ma, Jian-Ming Wu, Feng-Cai Guo, Suo-Cai Zhang, Department of Hepatology, Changzhou Third People's Hospital, Changzhou 213001, Jiangsu Province, China
Author contributions: Shao YL analyzed and interpreted the clinical data, and wrote the draft of this manuscript; Zhang SC reviewed the manuscript; Ma CM, Wu JM, and Guo FC collected the patient’s clinical information; all authors read and approved the final manuscript.
Supported byApplied Basic Research Project of Changzhou, No. CJ20190080.
Informed consent statement: The patient consented to all treatments and provided informed written consent prior to this case report.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: You-Lin Shao, MD, Chief Physician, Department of Hepatology, Changzhou Third People's Hospital, No. 300 North Lanling Road, Changzhou 213001, Jiangsu Province, China. syl84289@aliyun.com
Received: May 17, 2022 Peer-review started: May 17, 2022 First decision: June 16, 2022 Revised: June 24, 2022 Accepted: August 21, 2022 Article in press: August 21, 2022 Published online: September 26, 2022 Processing time: 122 Days and 9.2 Hours
Abstract
BACKGROUND
Various types of drug-induced liver injury are induced by Polygonum multiflorum (PM); however, it rarely causes neutropenia. Herein, we report the case of a 65-year-old woman with concurrent severe hepatotoxicity and agranulocytosis induced by PM.
CASE SUMMARY
A 65-year-old woman reported with severe hepatotoxicity and agranulocytosis 17 d after ingestion of PM. The results of the Roussel Uclaf Causality Assessment Method demonstrated a highly probable relationship between hepatotoxicity and PM, with a total score of 10. The Naranjo algorithm results indicated that agranulocytosis had a probable relationship with PM, with an overall score of 6. Granulocyte colony-stimulating factor (for once), a steroid, compound glycyrrhizin, and polyene phosphatidylcholine therapy were initiated. After 15 d of treatment, there was a gradual improvement in liver biochemistry, leukocytes, and neutrophils levels.
CONCLUSION
Concurrent hepatotoxicity and agranulocytosis are rare and critical adverse drug reactions of PM, which should be highly valued.
Core Tip: Polygonum multiflorum is a common traditional Chinese medicine and is commonly used as a dietary supplement. However, severe idiosyncratic hepatotoxicity in certain individuals has been reported. Moreover, if idiosyncratic agranulocytosis occurs simultaneously, it may be fatal. Roussel Uclaf Causality Assessment Method scale and Naranjo algorithm are useful tools for the assessment of drug-induced liver injury and adverse drug reactions, respectively. Early discontinuation can prevent disease progression, facilitating recovery. The combination therapy of glucocorticoids, anti-inflammatory medications, and liver protection is beneficial for idiosyncratic drug reactions.
