Reactivation of Pulmonary Tuberculosis in a Patient with Polygonum multiflorum Thunb-Induced Hepatitis

• Published in: Gut and liver Vol. 3; no. 1; pp. 52 - 56
• Main Authors: Cho, Hyun Chin, Min, Hyun Ju, Ha, Chang Yoon, Kim, Hyun Jin, Kim, Tae Hyo, Jung, Woon-Tae, Lee, Ok Jae, Bae, In-Gyu
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Gastroenterology; the Korean Society of Gastrointestinal Endoscopy; the Korean Association for the Study of the Liver; the Korean Society of Neurogastroenterology and Motility; Korean Association for the Study of Intestinal Diseases; Korean College of Helicobacter and Upper Gastrointestinal Research; Korean Society of Pancreatobiliary Diseases 01.03.2009; Gastroenterology Council for Gut and Liver; 거트앤리버 소화기연관학회협의회
• Subjects: bone marrow suppression; Case Report; hepatotoxicity; polygonum multiflorum thunb; pulmonary tuberculosis; 내과학; Bone marrow suppression; Polygonum multiflorum Thunb; Hepatotoxicity; Pulmonary tuberculosis
• ISSN: 1976-2283; 2005-1212; 2005-1212
• DOI: 10.5009/gnl.2009.3.1.52

Several cases of Polygonum multiflorum Thunb-induced hepatitis have been reported worldwide. Anthraquinone is an active ingredient of P. multiflorum Thunb. that has been thought to play a role in its hepatotoxicity. Here we report the case of a 34-year-old Korean man who had P. multiflorum Thunb-induced hepatitis and reactivation of pulmonary tuberculosis caused by bone marrow suppression, which developed simultaneously. He was admitted to our hospital with recently developed fatigue and aggravated jaundice. He was a previously healthy man except for the sequelae of pulmonary tuberculosis seen on chest X-ray. He had a 30-day history of ingesting the root of P. multiflorum as a form of liquor and tea. The patient was diagnosed with P. multiflorum Thunb-induced hepatitis after excluding all other potential causes of acute hepatitis. Liver function gradually improved following the total cessation of the consumption of the material. However, he suffered from spiking fever with progressive pancytopenia during the hospital stay. A bone marrow biopsy showed markedly hypocellular marrow, suggesting transient bone marrow suppression, which was probably caused by extrinsic factors such as drugs, toxins, and viral infection. Although he began to complain of a dry cough, repeated sputum investigations revealed positive acid-fast bacillus staining. The fever subsided and pancytopenia improved after treatment for pulmonary tuberculosis. These observations suggest that P. multiflorum Thunb induces both bone marrow suppression and hepatotoxicity.