Liver injury induced by herbal extracts containing mistletoe and kudzu

Along with the use of herbal medicines worldwide, the number of cases of reported herbal-induced hepatotoxicity has also been increasing. This report describes a case of liver injury caused by mistletoe and kudzu extracts in a patient previously in good health.

A 55-year-old man with no significant medical history was admitted to a hospital with a 10-day history of mild fever and brownish urine. The patient also had epigastric and right upper quadrant pain. The patient's liver function test results showed significantly elevated aspartate aminotransferase (AST) (958 IU/L) and alanine aminotransferase (ALT) (1000 IU/L) levels. Serologic viral hepatitis test results were negative. The patient neither consumed alcohol nor took any medications other than an antacid, which was not correlated with the elevated liver function test results. The patient reported taking mistletoe extract for 1 month and kudzu root extract for 10 days to promote his general health. Upon admission to the hospital, his AST and ALT levels were elevated to 1108 IU/L and 1528 IU/L, respectively. The total bilirubin level increased to 9.4 mg/dL on day 4. The modified Roussel Ulcaf Causality Assessment Method yielded a score of 10 points, indicating probable liver injury caused by mistletoe. Therefore, mistletoe- and kudzu-induced liver injury with a hepatocellular pattern was diagnosed. After discontinuation of the mistletoe and kudzu extracts in the hospital, the patient's liver function test values gradually decreased until day 8, with no other abnormal symptoms. The patient was discharged on hospital day 8 and had a follow-up visit at 1 week.

This case of liver injury characterized by a significant increase in AST and ALT levels was related to the use of mistletoe and kudzu extracts.