Concurrent severe hepatotoxicity and agranulocytosis induced by Polygonum multiflorum: A case report

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.

Keywords: Polygonum multiflorum; Hepatotoxicity; Agranulocytosis; Case report

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.