IntroductionLiv.52® is a multi-herbal marketed on advertised claims for various liver diseases. However, there is a lack of high-quality clinical evidence supporting its use. A randomized trial in alcohol-related cirrhosis showed no benefits but increased death. We present the first series of liver injuries associated with Liv.52® and report on the clinical presentations, liver histopathology, possible mechanisms of injury, and detailed /toxicology of the herbal formulation retrieved from patients.MethodsWe identified 15 cases of herb-induced liver injury (HILI) linked to Liv.52® on a retrospective review of a prospectively maintained patient database between Jun 1, 2019, and Jun 15, 2023. All patients underwent a detailed diagnostic workup to exclude other competing causes for liver injury. Where possible, the implicated Liv.52® formulation was retrieved for analysis.ResultsWe identified five patients with Liv.52®-induced HILI after reasonably excluding competing causes. Eighty percen