Rhabdomyolysis associated with Ophioglossum vulgatum consumption: a case series and safety implications.

BACKGROUND

O. vulgatum (Ophioglossum vulgatum, commonly known as "Yi Zhi Jian") is a traditional herbal medicine and food ingredient widely used for its heat-clearing and detoxifying properties and generally considered safe. However, its potential for severe muscular toxicity, particularly rhabdomyolysis, has not been systematically reported.

CASE PRESENTATION: A retrospective case series analysis was conducted on 10 patients admitted to the First People's Hospital of Neijiang City from 2024 to 2025 with O. vulgatum poisoning complicated by rhabdomyolysis. All patients ingested O. vulgatum for the purpose of "stewing soup", with a median latency period of 7 h. The predominant symptoms were severe myalgia (100%), fatigue (50%), and paresthesia (20%). The median peak creatine kinase (CK) level was 4099 U/L (range 2,427-17250 U/L). Acute kidney injury (AKI) complicated the course in one patient (10%). All patients immediately discontinued the herbal intake and received supportive treatment including aggressive hydration and urine alkalinization. The median hospital stay was 6 days. At the last follow-up, all patients survived, with complete resolution of muscular symptoms and recovery of renal function. The causal relationship between rhabdomyolysis and O. vulgatum was assessed as "probable" for all ten patients according to the WHO-UMC scale.

CONCLUSION

This is the first case series indicating an association between O. vulgatum consumption and severe rhabdomyolysis. Clinicians and the public should be aware of this risk and should avoid excessive or unconventional use. A detailed history of herbal medicine use is recommended for patients presenting with unexplained myalgia and elevated CK levels.