Acute liver failure caused by alkaloids from traditional Chinese medicine: A case report

Case reports of traditional Chinese medicine (TCM)-related liver injury have been relatively limited in the past decade. In more than 1200 cases of drug-induced liver injury, TCM accounted for 20.6% of the cases. Among the chemical components that cause important liver injury, alkaloids (such as chrysanthemum, notoginseng) are typical, mainly causing veno-occlusive disease, and progressing to liver failure in severe cases. Other alkaloids, such as aristolochic acid, have also been associated with liver cancer risk.

In this case report, we present a unique case of a 35-year-old female patient with progressive jaundice within one month after intake of alkaloid-containing TCM, followed by a rapid development of liver injury that progressed to liver failure, and finally, receiving liver transplantation. The clinical diagnosis of TCM-related liver injury is usually an exclusion diagnosis, with a lack of characteristic imaging signs or specific clinical symptoms, resulting in a delay in diagnosis.

This case shows that the patient received liver transplantation due to progressive liver failure after multiple conservative treatment modalities, thus, with a good prognosis and survival. It provides valuable guidance for the clinical diagnosis of liver injury and the timing of liver transplantation treatment caused by alkaloid hepatotoxic drugs.