Zhu XY, Zhao YT, Su CS, Yuan XD, Zhang SG, Nashan B. Acute liver failure caused by alkaloids from traditional Chinese medicine: A case report. World J Hepatol 2025; 17(10): 109575 [DOI: 10.4254/wjh.v17.i10.109575]
Corresponding Author of This Article
Björn Nashan, Professor, Department of Liver Transplantation, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Science and Medicine, University of Science and Technology of China, Hezeji Street, Shushan District, Hefei 230000, Anhui Province, China. bjoern.nashan@gmail.com
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Transplantation
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Case Report
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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/
Oct 27, 2025 (publication date) through Oct 27, 2025
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World Journal of Hepatology
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1948-5182
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Zhu XY, Zhao YT, Su CS, Yuan XD, Zhang SG, Nashan B. Acute liver failure caused by alkaloids from traditional Chinese medicine: A case report. World J Hepatol 2025; 17(10): 109575 [DOI: 10.4254/wjh.v17.i10.109575]
World J Hepatol. Oct 27, 2025; 17(10): 109575 Published online Oct 27, 2025. doi: 10.4254/wjh.v17.i10.109575
Acute liver failure caused by alkaloids from traditional Chinese medicine: A case report
Xuan-Yi Zhu, Yi-Teng Zhao, Chun-Sheng Su, Xiao-Dong Yuan, Shu-Geng Zhang, Björn Nashan
Xuan-Yi Zhu, Yi-Teng Zhao, Chun-Sheng Su, Department of Graduate School, Bengbu Medical University, Bengbu 233000, Anhui Province, China
Xuan-Yi Zhu, Yi-Teng Zhao, Chun-Sheng Su, Xiao-Dong Yuan, Shu-Geng Zhang, Björn Nashan, Department of Liver Transplantation, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Science and Medicine, University of Science and Technology of China, Hefei 230000, Anhui Province, China
Co-corresponding authors: Shu-Geng Zhang and Björn Nashan.
Author contributions: Zhu XY drafted the manuscript; Zhu XY, Zhao YT, and Su CS collected and obtained the data; Zhu XY, Zhang SG, and Nashan B analyzed and expounded on the data; Zhu XY and Nashan B designed the study; Yuan XD verified the data; Zhang SG provided a material foundation; Yuan XD, Zhang SG, and Nashan B reviewed and revised the manuscript; Zhang SG and Nashan B contributed equally to this manuscript and are co-corresponding authors. All authors approved the final manuscript.
Supported by Anhui Provincial Department of Education, No. 2022AH020077.
Informed consent statement: This study was approved by the Ethics Committee of the First Affiliated Hospital of the University of Science and Technology of China, and was compliant with the 1975 Declaration of Helsinki (No. 2025-RE-135). The patient provided a signed informed consent form before inclusion in the study.
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: Björn Nashan, Professor, Department of Liver Transplantation, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Science and Medicine, University of Science and Technology of China, Hezeji Street, Shushan District, Hefei 230000, Anhui Province, China. bjoern.nashan@gmail.com
Received: May 19, 2025 Revised: July 11, 2025 Accepted: September 19, 2025 Published online: October 27, 2025 Processing time: 163 Days and 20.6 Hours
Abstract
BACKGROUND
Case reports of traditional Chinese medicine (TCM)-related liver injury have been relatively limited in the past decade. In more than 1200 cases of drug-induced liver injury, TCM accounted for 20.6% of the cases. Among the chemical components that cause important liver injury, alkaloids (such as chrysanthemum, notoginseng) are typical, mainly causing veno-occlusive disease, and progressing to liver failure in severe cases. Other alkaloids, such as aristolochic acid, have also been associated with liver cancer risk.
CASE SUMMARY
In this case report, we present a unique case of a 35-year-old female patient with progressive jaundice within one month after intake of alkaloid-containing TCM, followed by a rapid development of liver injury that progressed to liver failure, and finally, receiving liver transplantation. The clinical diagnosis of TCM-related liver injury is usually an exclusion diagnosis, with a lack of characteristic imaging signs or specific clinical symptoms, resulting in a delay in diagnosis.
CONCLUSION
This case shows that the patient received liver transplantation due to progressive liver failure after multiple conservative treatment modalities, thus, with a good prognosis and survival. It provides valuable guidance for the clinical diagnosis of liver injury and the timing of liver transplantation treatment caused by alkaloid hepatotoxic drugs.
Core Tip: This case report presents a patient who suffered from liver damage due to the intake of alkaloid-containing traditional Chinese medicine and eventually achieved good therapeutic outcomes through liver transplantation. It explores the clinical diagnosis of liver damage caused by alkaloid hepatotoxic drugs and the appropriate timing for liver transplantation treatment, providing valuable guidance for clinical treatment.
