New case of acute hepatitis following the consumption of Shou Wu Pian, a Chinese herbal product derived from Polygonum multiflorum.

A case report of hepatotoxicity after consumption of Shou Wu Pian (an herbal remedy obtained from Polygonum multiflorum) by a 78-year-old Italian man is described. Symptoms were jaundice, nausea, abdominal pain, yellow skin, and dark urine. Physical examination revealed moderate hepatomegaly. Laboratory results showed high levels of bilirubin, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltranspeptidase, and alkaline phosphatase. Serologic and virologic markers for hepatitis A, B, C, and E viruses were negative. Blood samples were negative for hepatitis C virus RNA, hepatitis G virus RNA, cytomegalovirus, and Epstein–Barr virus. Autoimmune, metabolic, or other hepatotoxic causes were excluded. Clinical and laboratory measures improved rapidly after the patient discontinued using the herbal product. Quality control of preparation found no substitution or contamination of the product, which suggests that hepatotoxicity is related to the chemical components of the product and the manner of its use. The major constituents of P. multiflorum are polyphenols and anthraquinones. After intestinal metabolism, anthraquinones are transformed in anthrones. These highly reactive substances, when absorbed, can damage the liver.