Pediatr Gastroenterol Hepatol Nutr.  2012 Jun;15(2):111-116.

A Pediatric Case of Toxic Hepatitis Induced by Hovenia Dulcis

• Kim YJ
• Ryu SL
• Shim JW
• Kim DS
• Shim JY
• Park MS
• Jung HL

Abstract

Toxic hepatitis is a rare but devastating disease in children. Herbs are widely used in oriental medicine to treat various symptoms in Korea, however, several herbs have been reported to induce liver injury. We report a case of toxic hepatitis induced by Hovenia dulcis in a 3-year-old boy. He complained of nausea, abdominal discomfort, and jaundice. The patient had consumed water boiled with hovenia dulcis for about 1 year prior to presentation. A diagnosis of toxic hepatitis was made based on his history, laboratory data, viral markers, ultrasonography, and biopsied liver tissue. We administered supportive management for acute fulminant hepatitis but his symptoms and liver function progressed. He was transferred to another hospital for further evaluation and consideration for liver transplantation. Because acute liver failure due to herbs or dietary supplement taken for a long time is often fetal, it is important to make early diagnosis and stop taking the drug as soon as drug induced liver injury is suspected.

Keyword

Toxic hepatitis; Hovenia dulcis; Children

MeSH Terms

Biomarkers
Child
Dietary Supplements
Drug-Induced Liver Injury
Early Diagnosis
Hepatitis
Humans
Jaundice
Korea
Liver
Liver Failure, Acute
Liver Transplantation
Medicine, East Asian Traditional
Nausea
Preschool Child
Water
Water

Figure

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  Fig. 1 Abdominal ultrasonography of the case show. (A) Several enlarged lymph nodes of less than 1 cm at porta hepatitis. (B) Minimal effusion of perihepatic andperisplenic area, and (C) GB wall edema.

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  Fig. 2 Pathology findings of needle biopsied liver tissue show. (A) Some hepatocytic degeneration with frequent acidophilic bodies and balloon change (H&E, ×200). (B) Frequent spotty inflammatory collections in the hepatic lobule (H&E, ×200). (C, D) Some periportal fibrosis with some lymphoid infiltration, eosinophils and a few neutrophils (H&E, ×200).

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  Fig. 3 Changes in serum levels of aminotransferase and total bilirubin during the admission period. Both aminotransferase and bilirubin levels increased inspite of conservative therapy.

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