A Pediatric Case of Toxic Hepatitis Induced by Hovenia Dulcis

Kim, Yun Ji; Ryu, Seunghyong; Shim, Jae Won; Kim, Duk Soo; Shim, Jung Yeon; Park, Moon Soo; Jung, Hye Lim

doi:10.5223/pghn.2012.15.2.111

Cited by 12 publications

(16 citation statements)

References 14 publications

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“…RUCAM was also often applied in cases of liver injury caused by TCM herbs (Table 11) [80,82,104,105,110,111,112,113,120,122,134,138,151,162,164,165,186,221,278,279,280]. …”

Section: Rucam As the Preferred Methods To Assess Causality In LIVmentioning

confidence: 99%

“…Assumed causality was mostly based on clinical judgment, rarely on the results of liver specific causality assessment methods [70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130,131,132,133,134,135…”

Section: Tcm Herbs With Published Claims Of Hepatotoxic Potentialmentioning

confidence: 99%

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Traditional Chinese Medicine (TCM) and Herbal Hepatotoxicity: RUCAM and the Role of Novel Diagnostic Biomarkers Such as MicroRNAs

et al. 2016

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Background: Traditional Chinese Medicine (TCM) with its focus on herbal use is popular and appreciated worldwide with increased tendency, although its therapeutic efficacy is poorly established for most herbal TCM products. Treatment was perceived as fairly safe but discussions emerged more recently as to whether herb induced liver injury (HILI) from herbal TCM is a major issue; Methods: To analyze clinical and case characteristics of HILI caused by herbal TCM, we undertook a selective literature search in the PubMed database with the search items Traditional Chinese Medicine, TCM, alone and combined with the terms herbal hepatotoxicity or herb induced liver injury; Results: HILI caused by herbal TCM is rare and similarly to drugs can be caused by an unpredictable idiosyncratic or a predictable intrinsic reaction. Clinical features of liver injury from herbal TCM products are variable, and specific diagnostic biomarkers such as microsomal epoxide hydrolase, pyrrole-protein adducts, metabolomics, and microRNAs are available for only a few TCM herbs. The diagnosis is ascertained if alternative causes are validly excluded and causality levels of probable or highly probable are achieved applying the liver specific RUCAM (Roussel Uclaf Causality Assessment Method) as the most commonly used diagnostic tool worldwide. Case evaluation may be confounded by inappropriate or lacking causality assessment, poor herbal product quality, insufficiently documented cases, and failing to exclude alternative causes such as infections by hepatotropic viruses including hepatitis E virus infections; Conclusion: Suspected cases of liver injury from herbal TCM represent major challenges that deserve special clinical and regulatory attention to improve the quality of case evaluations and ascertain patients’ safety and benefit.

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“…RUCAM was also often applied in cases of liver injury caused by TCM herbs (Table 11) [80,82,104,105,110,111,112,113,120,122,134,138,151,162,164,165,186,221,278,279,280]. …”

Section: Rucam As the Preferred Methods To Assess Causality In LIVmentioning

confidence: 99%

Section: Tcm Herbs With Published Claims Of Hepatotoxic Potentialmentioning

confidence: 99%

Traditional Chinese Medicine (TCM) and Herbal Hepatotoxicity: RUCAM and the Role of Novel Diagnostic Biomarkers Such as MicroRNAs

et al. 2016

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“…First authors of reports from Korea contributed as experts were numbered overall 15, and thereby represented a substantial number of publications on 526 HILI cases that had been assessed for causality using RUCAM (Table 1). [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] These included single case reports, case series and review articles. Respective articles were mostly of good quality, with minor shortcomings.…”

Section: Koreamentioning

confidence: 99%

Herb-induced Liver Injury in Asia and Current Role of RUCAM for Causality Assessment in 11,160 Published Cases

Teschke¹,

Zhu²,

Jing³

2020

Journal of Clinical and Translational Hepatology

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Herb-induced liver injuries (HILI) by traditional herbal medicines are particular challenges in Asian countries, with issues over the best approach to establish causality. The aim of the current analysis was to provide an overview on how causality was assessed in HILI cases from Asian countries and whether the Roussel Uclaf Causality Assessment Method (RUCAM) was the preferred diagnostic algorithm, as shown before in worldwide evaluated cases of drug-induced liver injury (DILI). Using the PubMed database, publications in English language were preferred to allow for reevaluation by peers. Overall 11,160 HILI cases have assessed causality using RUCAM and were published by first authors working in Asian countries. With 21 evaluable reports, most publications came from mainland China, with Hong Kong and Taiwan, followed by Korea (n=15), Singapore (n=2), and Japan (n=1), while other Asian countries were not contributory. Most publications provided case and RUCAM data of good quality. For better presentation of future cases, however, the following recommendations are given: (1) preference of prospective study design with use of the updated RUCAM version; (2) clear separation of HILI cohorts from those of other herbal products or DILI; (3) case series for epidemiology studies should contain many essential data, possibly also as supplementary material; (4) otherwise, preference of single case reports providing individual case data and RUCAM-based causality gradings, and applying liver test threshold values; and (5) publication in English language journals. In conclusion, China and Korea are top in presenting RUCAM-based HILI cases, other Asian countries are encouraged to follow.

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“…However, consistent evidences indicate that the extended use of H. dulcis teas and infusions can lead to irreversible liver dysfunction, which only treatment is hepatic transplantation (Kim et al 2012).…”

Section: Introductionmentioning

confidence: 99%

“…Poisonous plants are capable of causing either direct or indirect health disorders and lowered vitality in humans and animals whenever ingested under natural conditions (Kim et al 2012).…”

Section: Introductionmentioning

confidence: 99%

Spontaneous poisoning by Hovenia dulcis in dairy cattle in Southwest Parana, Brazil

Bernardi

Possa

Faccin

et al. 2015

Trop Anim Health Prod

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Livestock poisoning by plants is a frequent occurrence which determines severe losses, such as the fall in the milk and meat production, the cost of expensive treatments, the state of immunosuppression, or even the animal's death. Cattle ingest toxic plants only when there is food shortage, when they cannot select what they eat, or when they ingest food for preference, which is the case of Hovenia dulcis fruits, very rich in sucrose. This plant is widely distributed in the southern and southeastern Brazilian regions. In literature, there are some cases of severe human liver injury associated with a long-term of H. dulcis leaf and fruit tea intake, and only one report regarding spontaneous poisoning of goats caused by this plant ingestion. However, its toxic effects associated with spontaneous ingestion by cattle have never been reported. This paper reports the first case of spontaneous poisoning in cattle by H. dulcis, which occurred in a dairy farm in southwest Paraná, Brazil. Three cattle individuals showed anorexia, ruminal atony, severe diarrhea and neurological tournament, head pressing, blindness, ataxia, and circling. The necropsy of the animals was done, and the remaining alterations were restricted to the digestive system and brain. The clinical signs presented by the animals are characteristic of polioencephalomalacia (PEM), caused by changes in the thiamine metabolism. Furthermore, clinical signs, gross, and microscopic lesions as well as the large amount of the plant throughout the digestive segment led to a diagnosis.

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A Pediatric Case of Toxic Hepatitis Induced by Hovenia Dulcis

Cited by 12 publications

References 14 publications

Traditional Chinese Medicine (TCM) and Herbal Hepatotoxicity: RUCAM and the Role of Novel Diagnostic Biomarkers Such as MicroRNAs

Traditional Chinese Medicine (TCM) and Herbal Hepatotoxicity: RUCAM and the Role of Novel Diagnostic Biomarkers Such as MicroRNAs

Herb-induced Liver Injury in Asia and Current Role of RUCAM for Causality Assessment in 11,160 Published Cases

Spontaneous poisoning by Hovenia dulcis in dairy cattle in Southwest Parana, Brazil

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