Liver Injury Associated With Irregular Herbal Products: A Translational Case Series With Chemical Authentication and Causality Assessment Using the Updated RUCAM.

BACKGROUND

Herb-induced liver injury (HILI) represents an increasing diagnostic challenge owing to the widespread use of herbal and dietary supplements (HDS), which are frequently consumed without reliable information regarding their composition or safety. Mischaracterized products may obscure causal attributes and mimic primary herbal hepatotoxicity.

METHODS AND

RESULTS

We report a case series of five patients with suspected HILI at a tertiary university hospital in Bahia, Brazil. Clinical causality was prospectively assessed using the updated Roussel Uclaf Causality Assessment Method (RUCAM, 2016). Most patients present with hepatocellular injury following exposure to commercially available HDS, frequently in the presence of metabolic comorbidities. Analytical authentication of the consumed products revealed substantial label-composition discordance, including negligible amounts of turmeric-derived constituents in a Curcuma longa formulation and multiple undeclared synthetic drugs in a weight-loss product. The integration of structured clinical assessment with product verification refined causal attribution and, in selected cases, supported the reclassification of suspected herbal hepatotoxicity as probable adulteration-related drug-induced liver injury.

CONCLUSION

Product authentication may substantially improve the diagnostic accuracy of suspected HILI and reduce the etiological uncertainty. Incorporating the verification of consumed supplements into hepatology evaluation may help distinguish true herbal hepatotoxicity from adulteration-related liver injury, thereby improving patient safety and pharmacovigilance.