Lea #exwaldi

A 56-year-old man was prescribed herbal formulations for anxiety by an Ayurvedic healer. Two weeks later, he developed abdominal pain, swelling of legs, fluid in abdomen (ascites) and chest (pleural effusion) and worsening jaundice (peak 40mg/dl) Investigations revealed massively enlarged liver, patent (no blocks) hepatic veins (large liver veins) and inferior vena cava (large abdominal vein) Conservative treatment did not improve his condition, culminating in liver transplantation. Explant liver was enlarged, bluish, with capsular stretching, and visibly sclerosed (thickened, blocked) hepatic venules (small liver veins, A, B, arrows). Biopsy revealed central vein occlusion (C), sinusoidal haemorrhage and hepatic necrosis, suggestive of veno-occlusive disease (VOD). The healthy living-donor liver is shown for comparison (D). Hepatic-VOD, a rare complication of inadvertent ingestion of plant-based toxic pyrrolizidine alkaloids (PAs) is a catastrophic syndrome first described with Senecio herbal tea consumption in 1920 in South Africa. Traditional Ayurvedic (or other herbal) preparations containing plants belonging to Compositae, Asteraceae, Boraginaceae and Leguminosae families are rich in PAs. Defibrotide is the only approved drug, but liver transplantation is curative. Our patient was discharged to home three-weeks later, uneventfully. Check your Ayurvedic/herbal supplements. You have one liver. Not always a donor is available. Stay safe.