Successful corticosteroid therapy for severe liver injury secondary to herbal traditional Chinese medicine, Mega Defends X, assessed for causality by the updated RUCAM: A case report

Abstract

Rationale: In China, herbal traditional Chinese medicine products are readily obtained without any requirement of prescription and widely used in real life, thereby increasing the incidence of their related herb-induced liver injury (HILI). However, the diagnosis of HILI is still challenging because its clinical manifestations are variable due to lack of any specific biomarkers. Misdiagnosis and inappropriate treatment may result in the progression of HILI. Patient concerns: A 55-year-old female patient was admitted to the hospital due to progressive jaundice. Diagnoses: The diagnoses of HILI secondary to Mega Defends X, an herbal traditional Chinese medicine product, for which the score was 9 based on the updated Roussel Uclaf Causality Assessment Method of 2016. Interventions: The patient received corticosteroid with a stepwise dosage reduction. Outcomes: The liver injury significantly improved by corticosteroid treatment. Lessons: Corticosteroids should be potentially effective and safe in patients with severe HILI.