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Acute Hepatitis Associated with the Chinese Herbal Product Jin Bu Huan
- Graham M. Woolf, MD;
- Lidija M. Petrovic, MD;
- Sergio E. Rojter, MD;
- Sherrilyn Wainwright, DVM, MPH;
- Federico G. Villamil, MD;
- William N. Katkov, MD;
- Pina Michieletti, MD;
- Ian R. Wanless, MD;
- Frank R. Stermitz, PhD;
- John J. Beck, BS; and
- John M. Vierling, MD
- From Cedars-Sinai Medical Center, Los Angeles, California; Centers for Disease Control and Prevention, Atlanta, Georgia; St. John's Hospital, Santa Monica, California; The Toronto Hospital, Toronto, Ontario, Canada; and Colorado State University, Fort Collins, Colorado. Requests for Reprints: Graham M. Woolf, MD, Hepatology and Liver Transplantation Programs, Cedars-Sinai Medical Center, Los Angeles, 8700 Beverly Boulevard, Suite #7511, Los Angeles, CA 90048. Acknowledgments: The authors thank Angela Hutzenbuhler, MD; Rick Perrie, MD; and Ronald Fishbach, MD, Andrew Lewin, MD, and Jerome Goldwasser, MD, for patient referral.
Abstract
Objective: To describe the hepatotoxicity associated with ingestion of the Chinese herbal product Jin Bu Huan Anodyne Tablets (Lycopodium serratum) and to propose possible mechanisms of injury.
Design: Retrospective analysis.
Setting: Academic hepatology units and private practice facilities.
Patients: Seven previously healthy patients.
Measurements: Clinical, laboratory, radiologic, and histologic studies.
Results: Acute hepatitis occurred after a mean of 20 weeks (range, 7 to 52 weeks) of Jin Bu Huan ingestion and resolved in six patients within a mean of 8 weeks (range, 2 to 30 weeks); another patient is currently improving. Hepatitis was associated with symptoms of fever, fatigue, nausea, pruritus, and abdominal pain and with signs of jaundice and hepatomegaly. Biopsy specimens showed that one patient had hepatitis with eosinophils (consistent with a drug reaction) and the other had mild hepatitis, moderate fibrosis, and microvesicular steatosis. Decreasing the Jin Bu Huan dose in one patient improved liver test results. Reusing Jin Bu Huan in two other patients caused abrupt recrudescence of hepatitis.
Conclusion: Jin Bu Huan can cause liver injury. Although the hepatotoxic mechanisms are not defined, they may include hypersensitive or idiosyncratic reactions or direct toxicity to active metabolites. Hepatotoxicity caused by herbal products underscores the importance of national surveillance programs and quality control of the manufacture of these products.
- Copyright ©2004 by the American College of Physicians
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