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

Table 1 Relevant laboratory examination reports on admission

Parameter	Result	Normal range
Liver and kidney function
Alanine aminotransferase	1442.8	7-40 U/L
Aspartate aminotransferase	1565	13-35 U/L
Alkaline Phosphatase	217	50-135 U/L
γ-glutamyl transferase	183.2	7-45 U/L
Total bilirubin	110	3.4-22 μmol/L
Direct bilirubin	91.1	1.7-10.3 μmol/L
Albumin	36.9	40-55 g/L
Globulin	22.3	20-40 g/L
Serum creatinine	43.6	35-80 μmol/L
Serum urea	4.74	2.9-8.2 mmol/L
Serum lipids
Total cholesterol	3.67	3.4-5.8 mmol/L
Low-density lipoprotein cholesterol	0.6	0.78-2 mmol/L
High-density lipoprotein cholesterol	1.91	0-3.7 mmol/L
Triglycerides	1.88	0.56-1.7 mmol/L
Coagulation function
Prothrombin Time	13.7	11.0-15.0 sec
Prothrombin activity	86.56	75%-160%
International normalized ratio	1.02	0.8-1.5
Complete blood count
Leukocyte	1.17	4.5-10 × 109 cells/L
Neutrophils	0.02	1.8-6.3 × 109 cells/L
Eosinophils	0	0.02-0.52 × 109 cells/L
Basophils	0	0-0.06 × 109 cells/L
Lymphocytes	0.98	1.1-3.2 × 109 cells/L
Monocytes	0.17	0.1-0.6 × 109 cells/L
Erythrocyte	4.07	3.8-5.1 × 1012 cells/L
Platelet	159	125-350 × 109 cells/L
Inflammatory markers
C-reactive protein	10.28	0-5 mg/L
Procalcitonin	0.192	0-0.05 ng/mL
Screening for causes of acute liver injury
Autoimmune liver diseases
Immunoglobulin A	1.4	0.72-4.29 g/L
Immunoglobulin G	13.3	8-17 g/L
Immunoglobulin G4	0.427	0.05-1.54 g/L
Immunoglobulin M	1.2	0.29-3.44 g/L
Anti-nuclear antibody	Negative
Anti-smooth muscle antibody	Negative
Anti-liver kidney microsome-1	Negative
Anti-soluble liver antigen/liver pancreas antigen	Negative
Anti-liver cytosol-1	Negative
Anti-centromere antibody	Negative
Anti-Mitochondrial-M2 antibody	Negative
Anti-gp210 antibodies	Negative
Anti-Sp100 antibodies	Negative
Virology test
Hepatitis A IgM	Negative
Hepatitis B surface antigen	Negative
Hepatitis B core antibody IgM	Negative
Hepatitis C antibody	Negative
Hepatitis E IgM	Negative
Anti-CMV IgM	Negative
Anti-EBV viral capsid antigen IgM	Negative
Anti-EBV early antigen IgM	Negative
COVID-19 RNA	Negative
HBV DNA	< 100	< 100 IU/mL
Thyroid function
Thyroid-stimulating hormone	0.8	0.56-5.91 uIU/mL
Free triiodothyronine	4.4	3.53-7.37 pmol/L
Free Thyroxine	14.68	7.98-16.02 pmol/L
Other
Ceruloplasmin	0.36	0.16-0.45 g/L
Alpha-fetoprotein	2.9	0.0-9.0 ng/mL

IgM: Immunoglobulin M; COVID-19: Coronavirus disease 2019; EBV: Epstein-Barr virus; CMV: Cytomegalovirus; HBV: Hepatitis B virus.

Table 2 Histological description of bone marrow aspiration at admission (total number of 200 nucleated cells)

Cell type	%	Reference value range
Myeloblasts	1.5	0.31-0.97
Promyelocytes	1.5	1.51-1.63
Neutrophilic myelocytes	2.5	4.45-8.53
Neutrophilic metamyelocytes	2	5.93-9.87
Neutrophilic stab granulocytes	0	20.22-27.22
Neutrophilic segmented granulocytes	0	6.52-12.36
Eosinophils	0	0.15-0.61
Basophils	0	0.00-0.07
Pronormoblasts	0.5	0.27-0.87
Early erythroblasts	0.5	0.51-1.33
Polychromatic normoblasts	12.5	5.5-9.32
Orthochromatic normoblasts	33.5	8.39-13.11
Lymphocytes	42.5	15.71-29.82
Monocytes	2.5	2.12-3.88
Plasmacytes	0.5	0.29-1.13
Total	100
Myeloid:erythroid ratio	0.16	2-4:1