Budd-Chiari syndrome secondary to toxic pyrrolizidine alkaloid exposure

Herb-induced medical illnesses including hepatotoxicity has now become a global medical and pharmacological issue. Although perceived as safe, many consequences had been associated with chronic Khat consumption. The association between the consumption of the plant Catha edulis (Khat) and acute liver injury, chronic hepatitis and cirrhosis had evidently occupied the literature. Khat induced hepatotoxicity has been recently asserted by reports of khat-induced hepatic venous thrombosis. Still remaining in the shadow is the natural history of Khat related liver damage.

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“…Budd-Chiari syndrome was recently reported in a 10-month-old boy after consuming cathinone containing herbal drink for 3 months [30].…”

Section: Khat Thrombogenicitymentioning

confidence: 97%

Khat Intertwined Liver Damage

Alhaddad¹,

Elsabaawy²,

Waked³

2017

J Infect Dis Ther

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“…[42][43][44] Certain types of traditional Chinese medicine, such as Flos farfarae and Herba senecionis scandentis, are potential sources of pyrrolizidine alkaloids exposure in Hong Kong, 45,46 but toxicity due to wild plant consumption is relatively rare. 14 Timely diagnosis of plant poisonings is very difficult. Local epidemiology data are scarce, and reports published in other parts of the world are of limited use because plant species are geographically specific.…”

Section: Fig 2 Flowchart Showing Morphological Identification and Bimentioning

confidence: 99%

“…Some of the cases have been previously published as case reports by the authors and other units. [12][13][14][15][16][17][18][19] Funding/support This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.…”

Section: Author Contributionsmentioning

confidence: 99%

“…4 Consumption of wild plants as "medicinal herbs" or food is not an uncommon practice in Hong Kong, and severe plant poisoning cases have been reported. [11][12][13][14][15][16][17][18][19] However, local epidemiology data on plant poisoning are ORIGINAL ARTICLE patients (n=61, 98%) used the plants intentionally: as a medicinal herb (n=31), as food (n=29), and for attempting suicide (n=1). Reasons for using the poisonous plants included misidentification (n=34, 55%), unawareness of the toxicity (n=20, 32%), and contamination (n=6, 10%).…”

Section: Introductionmentioning

confidence: 99%

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Poisoning by toxic plants in Hong Kong: a 15-year review

Hung

Lam

et al. 2019

Hong Kong Med J

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has a great diversity of plants, many of which are toxic to humans. The aim of this study was to identify the plant species most commonly involved in cases of plant poisoning in Hong Kong and to provide clinicians with a reference tool for the diagnosis and management of plant poisoning. Methods: We retrospectively reviewed all plant poisoning cases referred to the Hospital Authority Toxicology Reference Laboratory from 1 January 2003 to 31 December 2017. Demographics, clinical presentation, laboratory findings, treatment and outcomes of patients, as well as morphological identification and analytical testing of the plant specimens, were investigated. Results: A total of 62 cases involving 26 poisonous plant species were identified, among which Alocasia macrorrhizos (Giant Alocasia), Gelsemium elegans (Graceful Jessamine), and Rhododendron (Azalea) species were the three most commonly encountered. Gastrointestinal toxicity (n=30, 48%), neurological toxicity (n=22, 35%), and hepatotoxicity (n=6, 10%) were the three most common clinical problems. Forty-nine (79%) and eight (13%) patients had mild and moderate toxicity, respectively; they all recovered shortly with supportive treatment. The remaining five (8%) patients experienced severe toxicity requiring intensive care support. Most

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“…Plants contain pyrrolizidine alkaloid in different preparations, and this substance has been repeatedly incriminated since it causes endothelial damage and consequent triggering of coagulation. 83 In the natural form, pyrrolizidine alkaloids have little toxicity but become toxic pyrroles once metabolized by the liver. This effect is particularly evident in the hepatic veins and justifies the selectivity of the thrombotic manifestation.…”

Section: Herbal (Preparation) Drinksmentioning

confidence: 99%

Drug-Induced Thrombophilic or Prothrombotic States: An Underestimated Clinical Problem That Involves Both Legal and Illegal Compounds

Girolami

Cosi

Tasinato

et al. 2016

Clin Appl Thromb Hemost

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Vascular thrombosis, both arterial and venous, is a condition associated with significant morbidity and mortality. There are multiple risk factors for thrombosis, both congenital and acquired, and in the majority of cases, these risk factors are not modifiable. Over the past 2 decades, multiple drugs (both illegal and legal) have been associated with increased risk of thrombosis. However, due to limited scientific literature regarding the prothrombotic tendencies of these drugs, there is a concomitant limited understanding of the pathophysiology of drug-induced thrombosis. As drugs are one of the few modifiable risk factors for thrombosis, further study and dissemination of knowledge regarding drug-associated and drug-induced thrombosis are essential and have the potential to lead to decreased future incidence of thrombosis. The mechanisms at the basis of the thrombophilic activity of these drugs are variable and sometimes still ill recognized. Increased levels of clotting factors, reduction in coagulation natural inhibitors, decreased fibrinolysis, activated clotting factors, increased blood viscosity, endothelial damage, and increased platelet number and activation are the most frequent causes. Arterial steal or coronary arteries no flow has also been implicated. In some cases due to the intake of several drugs, more than one mechanism is present in a given patient. The purpose of the present review is to analyze all the drugs demonstrated to be potentially thrombotic. It is hoped that a prudent use or nonuse of these drugs might result in a reduction of thrombosis-associated diseases.

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Budd-Chiari syndrome secondary to toxic pyrrolizidine alkaloid exposure

Cited by 7 publications

References 13 publications

Khat Intertwined Liver Damage

Khat Intertwined Liver Damage

Poisoning by toxic plants in Hong Kong: a 15-year review

Drug-Induced Thrombophilic or Prothrombotic States: An Underestimated Clinical Problem That Involves Both Legal and Illegal Compounds

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