Hepatic sinusoidal obstruction syndrome caused by the ingestion of Gynura segetum in a patient with alcoholic cirrhosis: a case report

Abstract

Hepatic sinusoidal obstruction syndrome (HSOS) is a rare hepatic vascular disorder characterized by intrahepatic congestion, liver injury, and post-sinusoidal portal hypertension, and it is frequently associated with hematopoietic stem cell transplantation. In this study, we observed a case of HSOS associated with the ingestion of Gynura segetum, a pyrrolizidine alkaloid (PA)-containing Chinese herb, in a patient with alcoholic cirrhosis. The patient was a 43-year-old man with chief complaints of physical asthenia and a loss of appetite for more than a month. The diagnosis of HSOS combined with alcoholic cirrhosis was confirmed via the histopathological examination of liver tissues. With proper supportive and symptomatic care and anticoagulation therapy using low-molecular-weight heparin, the patient’s condition was stabilized. Because of its nonspecific symptoms in the early stage and a lack of information about PA consumption, PA-induced HSOS (PA-HSOS) has been long neglected, especially in patients with underlying liver diseases. Early identification and intervention are critical for optimizing outcomes. Further efforts are needed to supervise the use of PA-containing herbal medicines and identify accurate biomarkers for PA-HSOS.

Metabolic Toxification of 1,2-Unsaturated Pyrrolizidine Alkaloids Causes Human Hepatic Sinusoidal Obstruction Syndrome: The Update

“…The very early literature on PA-HSOS in adults commonly presents case reports of limited value, often lacking a robust causality assessment, and current biomarker such as PPAs were not available at that time. Considering the experimental studies and PA-HSOS cases published recently [ 239 , 244 , 245 , 246 , 247 , 248 , 249 , 250 ], details of selected cases will be provided. RUCAM was used to assess causality in some of the reports [ 244 , 251 ], but not in others [ 239 , 245 , 246 , 248 , 249 ].…”

“…Considering the experimental studies and PA-HSOS cases published recently [ 239 , 244 , 245 , 246 , 247 , 248 , 249 , 250 ], details of selected cases will be provided. RUCAM was used to assess causality in some of the reports [ 244 , 251 ], but not in others [ 239 , 245 , 246 , 248 , 249 ].…”

“…The 43-year-old male patient had consumed 450 mL of 30% alcohol, daily, for 20 years and consumed 150 g of medicinal liquor containing Gynura segetum for ten days before developing symptoms [ 248 ]. The diagnosis of HSOS combined with alcoholic cirrhosis was made using liver histology.…”

Green Alternatives in Treatment of Liver Diseases: the Challenges of Traditional Medicine and Green Nanomedicine

“…In contrast to this preventive effect, the aforementioned tea constituents inhibit the activities of SOD, CAT, and ALDH, which are involved in antioxidant activity, [22] where the need arises to study the adverse effects that the different types of tea may present or to look for alternative dosage forms of their phytoconstituents. On the other hand, an example of a clinical case of ALD of a patient who presented hepatic sinusoidal obstruction syndrome due to the ingestion of Gynura segetum for ten days; This plant contains the alkaloid pyrrolizidine (PA), this compound, with 1,2‐unsaturated necine base, is known to cause hepatic veno‐occlusive disease (HVOD) in humans and animals after acute exposure, which indicates the risk of consuming natural products without medical supervision, since most people are unaware of such effects, and this toxicity may be overlooked in patients with liver disease [23] …”

Serum metabolomics strategy for investigating the hepatotoxicity induced by different exposure times and doses of Gynura segetum (Lour.) Merr. in rats based on GC-MS

“…Merr., called Tusanqi in China, is a plant of the Asteraceae family. 1 It has been widely used in Chinese folk medicine and can promote circulation, relieve pain and remove stasis. 2 The chemical components of GS mainly include alkaloids, flavones, coumarins and triterpenes, etc.…”