title: Hepatic venocclusive disease associated with the consumption of pyrrolizidine-containing dietary supplements.
abstract: Venocclusive disease, a form of Budd-Chiari syndrome, was diagnosed in a 49-yr-old woman. The patient had portal hypertension associated with obliteration of the smaller hepatic venules. A liver biopsy specimen showed centrilobular necrosis and congestion. Analysis of food supplements the woman regularly consumed showed the presence of pyrrolizidine alkaloids. The major source was a powder purporting to contain ground comfrey root (Symphytum sp). We calculated that during the 6 mo before the woman was hospitalized, she had consumed a minimum of 85 mg of pyrrolizidine alkaloids (15 micrograms/kg body wt X day). The clinical and analytic findings were consistent with chronic pyrrolizidine intoxication, indicating that low-level, chronic exposure to such alkaloids can cause venocclusive disease.
mesh_terms: D006502:Budd-Chiari Syndrome / Q000139:chemically induced* / Q000150:complications; D056486:Chemical and Drug Induced Liver Injury; D005260:Female; D005527:Food, Fortified / Q000032:analysis / Q000506:poisoning*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008875:Middle Aged; D009336:Necrosis; D011763:Pyrrolizidine Alkaloids / Q000032:analysis / Q000506:poisoning*
chemical_list: D011763:Pyrrolizidine Alkaloids