Frontiers in pharmacology · 2026
Case Report: Pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome misdiagnosed as ovarian malignancy.
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Wang Ke, Wang Shuhua, Wang Yijuan, Lu Jing, Wang Huiling, Hua Fangfang, Yang Jun
Аннотация
BACKGROUND: Hepatic Sinusoidal Obstruction Syndrome (HSOS), formerly known as Hepatic Veno-Occlusive Disease (HVOD), is a rare and life-threatening liver condition. It is often caused by the ingestion of pyrrolizidine alkaloids (PAs), which are found in plants such as Gynura segetum (Tusanqi). Because its clinical presentation is non-specific, HSOS is frequently misdiagnosed.
CASE PRESENTATION: A 72-year-old female with a 5-year history of type 2 diabetes presented with abdominal distension and anorexia for 2 weeks. Initial examinations revealed massive ascites and significantly elevated tumor markers (Cancer Antigen 125(CA125): 195.0 U/mL, Human Epididymis Protein 4(HE4): 120.1 pmol/L). Imaging suggested potential ovarian cancer, leading to diagnostic laparoscopy and bilateral adnexectomy. However, intraoperative findings and post-operative pathology showed no evidence of malignancy, identifying only a serous cystadenoma. Subsequent detailed history-taking revealed long-term ingestion of "Tusanqi." Re-evaluation via contrast-enhanced CT and MRCP showed characteristic patterns: patchy enhancement of hepatic parenchyma ("geographic" pattern), narrow hepatic veins, and signs of portal hypertension. The patient was finally diagnosed with PA-induced HSOS. Following a regimen of anticoagulation (low-molecular-weight heparin), liver protection, and diuretics, the patient's abdominal distension relieved, and liver function markers showed partial recovery. The patient underwent laparoscopic bilateral adnexectomy due to a high suspicion of ovarian cancer, but the postoperative pathology ruled out malignant tumors, resulting in unnecessary surgical trauma. This article aims to improve the warning effect.
CONCLUSION: This case highlights the clinical challenge of distinguishing HSOS from abdominal malignancies. A thorough dietary/herbal history and characteristic "geographic" enhancement on imaging are pivotal for avoiding unnecessary surgical interventions.
CASE PRESENTATION: A 72-year-old female with a 5-year history of type 2 diabetes presented with abdominal distension and anorexia for 2 weeks. Initial examinations revealed massive ascites and significantly elevated tumor markers (Cancer Antigen 125(CA125): 195.0 U/mL, Human Epididymis Protein 4(HE4): 120.1 pmol/L). Imaging suggested potential ovarian cancer, leading to diagnostic laparoscopy and bilateral adnexectomy. However, intraoperative findings and post-operative pathology showed no evidence of malignancy, identifying only a serous cystadenoma. Subsequent detailed history-taking revealed long-term ingestion of "Tusanqi." Re-evaluation via contrast-enhanced CT and MRCP showed characteristic patterns: patchy enhancement of hepatic parenchyma ("geographic" pattern), narrow hepatic veins, and signs of portal hypertension. The patient was finally diagnosed with PA-induced HSOS. Following a regimen of anticoagulation (low-molecular-weight heparin), liver protection, and diuretics, the patient's abdominal distension relieved, and liver function markers showed partial recovery. The patient underwent laparoscopic bilateral adnexectomy due to a high suspicion of ovarian cancer, but the postoperative pathology ruled out malignant tumors, resulting in unnecessary surgical trauma. This article aims to improve the warning effect.
CONCLUSION: This case highlights the clinical challenge of distinguishing HSOS from abdominal malignancies. A thorough dietary/herbal history and characteristic "geographic" enhancement on imaging are pivotal for avoiding unnecessary surgical interventions.