A case of repeated liver injury induced by different herbal medicines containing the same components

Abstract

A 61-year-old woman was referred to our hospital because of anorexia, nausea, and elevated serum hepatic and biliary enzymes. She had earlier undergone treatment with oral administration of the herbal medicine Sai-rei-to for 29 days. Viral markers were negative for hepatitis A, B, C, and E. Autoimmune hepatitis and primary biliary cirrhosis were also ruled out. Liver injury related to Sai-rei-to was suspected due to a high possibility score of 9 according to a scale, proposed by a workshop on drug-induced liver injury held during DDW-J 2004. Moreover, a drug-induced lymphocyte stimulation test (DLST) was positive for Sai-rei-to. The patient gradually recovered after a bout of overt jaundice. One and a half years later, she was readmitted due to elevated hepatic and biliary enzymes after taking another herbal medicine, Saiko-keishi-to, for 14 days. Both drugs contained 8 identical substances. A DLST was performed on each component and revealed positive results for Ogon and Kanzo. Clinicians should bear in mind that many herbal medicines share similar constituents when administering such drugs to patients with a history of herbal medicine-induced liver injury.