Liver Injury Associated With Irregular Herbal Products: A Translational Case Series With Chemical Authentication and
Ferdinando Lucas Góis1, Rebeca Santos do Amaral de Souza2, Raymundo Paraná2
1Postgraduate Program in Pharmaceutical Assistance (PPGASFAR), Faculty of Pharmacy, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil, ufba.br.
Case Reports in Hepatology
|July 23, 2026
Summary
Diagnosing herb-induced liver injury (HILI) is challenging due to supplement variability. Product authentication is crucial for distinguishing true HILI from adulteration, improving patient safety and diagnosis.
Area of Science:
- Hepatology
- Pharmacovigilance
- Toxicology
Background:
- Herb-induced liver injury (HILI) poses diagnostic challenges due to the widespread use of herbal and dietary supplements (HDS).
- Mischaracterized HDS products can obscure causal links and mimic primary herbal hepatotoxicity.
Purpose of the Study:
- To investigate the role of product authentication in diagnosing HILI.
- To differentiate true herbal hepatotoxicity from adulteration-related liver injury.
Main Methods:
- A case series of five patients with suspected HILI was analyzed.
- Clinical causality was assessed using the updated Roussel Uclaf Causality Assessment Method (RUCAM).
- Analytical authentication of consumed HDS products was performed.
Main Results:
- Most patients presented with hepatocellular injury after consuming commercially available HDS, often with metabolic comorbidities.
- Product authentication revealed significant label-composition discrepancies, including undeclared synthetic drugs and low levels of stated ingredients.
- Product verification helped reclassify suspected HILI as probable adulteration-related drug-induced liver injury in some cases.
Conclusions:
- Product authentication significantly enhances diagnostic accuracy for suspected HILI.
- Integrating supplement verification into hepatology evaluations aids in distinguishing true herbal hepatotoxicity from adulteration.
- Improved diagnostic accuracy supports better patient safety and pharmacovigilance.