Four cases of toxic liver injury associated with Dictamnus dasycarpus

Abstract

We report four cases of toxic hepatitis that occurred after taking a decoction made by boiling down the root of Dictamnus dasycarpus. The four patients had a median age of 60 years, common symptoms of jaundice and general weakness, and stated that they had not consumed alcohol for at least 5 years. The markers of hepatitis A, B, and C were all negative in the patients. Abdominal ultrasonography revealed common bile ducts with normal diameters. Two of the cases were a mother and daughter, and the other two were sporadic. All of them had consumed a decoction made by boiling down the root of Dictamnus dasycarpus five or six times daily until several days before admission. Dictamnus dasycarpus induced liver injury presenting with a benign course lasting less than 1 month after cessation of the causative agent. We suggest that this natural product can cause acute hepatitis in rural areas.

Traditional Chinese Medicine (TCM) and Herbal Hepatotoxicity: RUCAM and the Role of Novel Diagnostic Biomarkers Such as MicroRNAs

“…Assumed causality was mostly based on clinical judgment, rarely on the results of liver specific causality assessment methods [70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130,131,132,133,134,135…”

“…In four Korean patients, the use of the herbal TCM Bai Xian Pi ( Dictamnus dasycarpus ) was hepatotoxic, when applied as a single herb [75], and in three other patients from the United Kingdom, when it was coadministered with other herbs [76,77,78]. Fourteen patients from Korea developed ALF due to Dictamnus dasycarpus [79], and two other Korean patients experienced ALF that needed a liver transplant [80].…”

Medicinal uses, phytochemistry and pharmacology of the genus Dictamnus (Rutaceae)

“…The four patients had a median age of 60 years, common symptoms of jaundice and general weakness (Jang et al, 2008). Wang et al evaluated the safety of Cortex Dictamni aqueous extract by acute and sub-chronic toxicity studies in mice and rats.…”

Liver Injury Induced by Herbal Extracts Containing Mistletoe and Kudzu

“…Some herbals, such as dittany bark (Dictamnus dasycarpus) and ma-huang (Ephedra sinica), are intrinsically toxic and frequently reported as hepatotoxins. [16][17][18][19] However, limited literature is available on mistletoe-induced liver injury, with one case published in 1981, 20 or on kudzu-induced liver injury, with two cases published in Korea. 21 The current report describes a case of liver injury associated with herbal extracts containing mistletoe and kudzu in a patient who had previously been in good health.…”