Successful treatment of an adult with Amanita phalloides-induced fulminant liver failure with molecular adsorbent recirculating system (MARS).
Despite significant advances in intensive care management of Amanita phalloides-induced fulminant liver failure (FLF), patients with this condition still have a high mortality rate in the absence of orthotopic liver transplantation. Molecular Adsorbent Recirculating System (MARS) is a new, cell-free, extracorporeal liver assistance method utilizing an albumin dialysate for the removal of albumin-bound toxins, and a highly effective depurative therapy in adults with wild mushroom-induced FLF. We report the case of a 39 year old woman with Amanita phalloides-induced FLF, admitted to our intensive care unit (ICU) and treated with MARS. Our patient had severe hepatic dysfunction: hepatic encephalopathy (grade II), ALT = 5022 (2475-10098) IU/L, bilirubin = 7.18 (4.8-10.1) mg/dL, prothrombin time (PT) = 90.4 (29.3-140.4) s. MARS sessions had an immediate impact on liver tests: statistically significant decrease in ammonia, ALT and PT. Hepatic encephalopathy was successfully reduced. The patient survived and the hepatic function completely recovered. MARS appears to be a safe and highly effective depurative therapy in adults with Amanita phalloides-induced FLF.
Lionte
Cătălina
C
Medical Department, Emergency Clinic Hospital, University of Medicine and Pharmacy, Iaşi, Romania. clionte@yahoo.com
Sorodoc
Laurenţiu
L
Simionescu
Victoriţa
V
D000328:Adult; D000545:Amanita / Q000472:pathogenicity; D005112:Extracorporeal Circulation; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000628:therapy; D006801:Humans; D017114:Liver Failure, Acute / Q000209:etiology / Q000628:therapy*; D009145:Mushroom Poisoning / Q000150:complications*; D016060:Sorption Detoxification; D016896:Treatment Outcome