CHINESE HERBAL MEDICINE IMPLICATED IN LIVER FAILURE

Another case of acute hepatitis and liver failure linked to consumption of the Chinese herbal medication, ma-huang, has been reported by clinicians at the University of California at San Francisco (UCSF).

A 63-year-old Chinese woman developed fulminant liver failure requiring transplantation following the use of the mixture of 12 plant species. She was one of three people who presented to UCSF with acute hepatitis associated with Chinese herbal medications during a two-month period.

"The patient transplanted did not have a history of chronic liver disease nor alcohol consumption," Eric M. Yoshida and colleagues from UCSF wrote ("Chinese Herbal Medicine, Fulminant Hepatitis, and Liver Transplantation," American Journal of Gastroenterology, December 1996;91(12):1647-1648). "Viral studies, however, revealed seropositivity for hepatitis B surface antigen and hepatitis B core antibody (HBcAb) IgG; serum hepatitis B virus DNA was 511."

Lake et al. noted that serology for HBcAb IgM was negative. Serologies for hepatitis C, hepatitis A IgM, and hepatitis D, likewise, were negative.

When first admitted to the hospital, the woman was notably jaundiced and encephalopathic with no stigmata of chronic liver disease, and initial clinical impression was of fulminant viral hepatitis. A history was taken and the woman acknowledged taking the Chinese herbal medication ma-huang for a one-week period four weeks before admission.

Coagulopathy, jaundice, and encephalopathy progressively worsened requiring endotracheal intubation. Liver transplantation was performed and gross inspection of the explanted liver revealed marked collapse and very small regenerative nodules. Histologic examination of the explant revealed massive centrilobular necrosis with periportal bile ductular proliferation and inflammation.

The UCSF cases are not the first to implicate ma-huang in the development of acute hepatitis and liver failure. In 1996, Nadir et al. also reported such a case (Am J Gastroenterol 1996;91:1436-1438).

"Our transplanted patient would have had a fatal outcome, which is infrequently reported, had an allograft not been available," Yoshida et al. wrote.

"The recent experience at UCSF demonstrates that liver injury from traditional Chinese medicines does not always resolve, and urgent transplantation may be required. It remains to be seen whether or not the recent cluster of cases at UCSF represents a trend that grows with the increasing use of 'alternative' medicines."

The corresponding author for this study is John R. Lake, Department of Medicine and Pathology, University of California at San Francisco..