1例66岁男性患者为缓解疥疮导致的皮肤瘙痒，自行以狗舌草泡水间断饮用。近2年后出现腹胀、腹痛、纳差、尿黄症状。实验室检查示总胆红素（TBil）158.2 μmol/L，直接胆红素（DBil）73.5 μmol/L，丙氨酸转氨酶（ALT）96 U/L，天冬氨酸转氨酶（AST）131 U/L，胆碱酯酶1.40 kU/L，国际标准化比值（INR）1.7。上腹部磁共振检查显示符合肝窦阻塞综合征表现。排除其他病因后考虑其为狗舌草导致。予以保肝、利尿、营养支持、抗凝、降低门静脉压力等对症支持治疗，但患者症状持续加重，间断出现肝性脑病及消化道出血等并发症。治疗67 d后，患者TBil 192.0 μmol/L，DBil 96.7 μmol/L，ALT 118 U/L，AST 193 U/L，胆碱酯酶0.72 kU/L。患者及家属要求出院，出院5 d后患者死亡。 A 66-year-old male patient intermittently drank soading water of Tephroseris kirilowii by himself to alleviate skin itching caused by scabies. After nearly 2 years, he developed symptoms of abdominal distension, abdominal pain, poor appetite, and yellow urine. Laboratory tests showed total bilirubin (TBil) 158.2 μmol/L, direct bilirubin (DBil) 73.5 μmol/L, alanine aminotransferase (ALT) 96 U/L, aspartate aminotransferase (AST) 131 U/L, cholinesterase 1.40 kU/L, and international normalized ratio (INR) 1.7. Magnetic resonance imaging examination of upper abdomen showed consistent performance with the manifestation of hepatic sinusoidal obstruction syndrome. After excluding other causes, it was considered that it was caused by Tephroseris kirilowii. Supportive treatments such as anti-infection, liver protection, diuresis, nutritional support, anticoagulation, and reducing portal vein pressure were given. But the patient′s symptoms continue to worsen, with intermittent complications such as hepatic encephalopathy and gastrointestinal bleeding. After 67 days of treatments, laboratory tests showed TBil 192.0 μmol/L, DBil 96.7 μmol/L, ALT 118 U/L, AST 193 U/L, and cholinesterase 0.72 kU/L. The patient was discharged upon request from himself and the families, and died 5 days later.
Abstract
A 66-year-old male patient intermittently drank soading water of Tephroseris kirilowii by himself to alleviate skin itching caused by scabies. After nearly 2 years, he developed symptoms of abdominal distension, abdominal pain, poor appetite, and yellow urine. Laboratory tests showed total bilirubin (TBil) 158.2 μmol/L, direct bilirubin (DBil) 73.5 μmol/L, alanine aminotransferase (ALT) 96 U/L, aspartate aminotransferase (AST) 131 U/L, cholinesterase 1.40 kU/L, and international normalized ratio (INR) 1.7. Magnetic resonance imaging examination of upper abdomen showed consistent performance with the manifestation of hepatic sinusoidal obstruction syndrome. After excluding other causes, it was considered that it was caused by Tephroseris kirilowii. Supportive treatments such as anti-infection, liver protection, diuresis, nutritional support, anticoagulation, and reducing portal vein pressure were given. But the patient′s symptoms continue to worsen, with intermittent complications such as hepatic encephalopathy and gastrointestinal bleeding. After 67 days of treatments, laboratory tests showed TBil 192.0 μmol/L, DBil 96.7 μmol/L, ALT 118 U/L, AST 193 U/L, and cholinesterase 0.72 kU/L. The patient was discharged upon request from himself and the families, and died 5 days later.
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