A case report and a literature review of drug-induced liver injury caused by Huzhang according to the updated RUCAM

RATIONALE: Herbal medicine-induced hepatotoxicity is a significant contributing factor to drug-induced liver injury (DILI), but the mechanisms underlying herbal medicine-induced hepatotoxicity remain unclear. This study reports a well-documented probable case of DILI caused by Huzhang (Polygoni Cuspidati Rhizoma et Radix) to elucidate its clinical presentation and potential mechanisms. PATIENT CONCERNS: A 72-year-old patient developed hepatocyte-type damage after continuous administration of a Huzhang-containing formula for 14 days. DIAGNOSES: After ruling out other causes via comprehensive exams, we reviewed the literature, excluded other medications, and applied the updated Roussel Uclaf Causality Assessment Method, which gave a score of 6 for Huzhang-induced DILI. INTERVENTIONS: The patient was treated with N-acetylcysteine and other supportive medications. OUTCOMES: The patient's liver function returned to normal after treatment. LESSONS: The hepatotoxicity mechanism of emodin in Huzhang was explored, and it was suggested that traditional Chinese medicines containing emodin, such as Huzhang, should be cautious about hepatotoxicity risks, particularly in elderly patients, long-term users, and those with a history of surgery.