Epimedium spp. as a trigger of acute liver failure

Introduction Nowadays, people inform themselves on the internet about complementary treatments for various medical problems. Epimedium spp., ivory flowers, also known as "horny-goat weed" is heavily advertised on the internet as a remedy for erectile dysfunction, libido problems in both sexes, osteoporosis and liver disease. Potential hepatotoxicity has not been reported to date.

Case report We present a case-report of a 40-year old female patient, who presented with upper abdominal pain and jaundice (ALT 2600 U/l, AST 1863 U/l, gGT 128 U/l, total bilirubin). The initially suspected choledocholithiasis could be excluded through abdominal MRI and ERCP. In the course, the patient developed an acute liver failure with impaired hepatic synthesis and excretory function. Detailed medical history collection was unobtrusive, except for an ivory flower-based aphrodisiac. Liver biopsy revealed changes in line with a severe drug-induced liver injury with zone 3-necrosis spreading more than half of the liver parenchyma. After referral to our liver unit, the patient fulfilled the King’s College criteria for non-aminoacetophen induced acute liver failure on the fifth day and was listed for liver transplantation with high urgent priority. She was successfully transplanted after four days on the waiting list. The postoperative course remained uneventful.

Conclusion Our case report advocates for more public education about idiosyncratic hepatotoxins. The use of Epimedium spp. should be avoided due to the potential to induce severe drug-induced liver injury with fulminant acute liver failure.

Publication History

Article published online:
23 January 2024