Grunes Dianne E, Scordi-Bello Irini, Suh Matthew, Florman Sander, Yao Jonathan, Fiel Maria Isabel, Thung Swan N
Department of Pathology, Mount Sinai School of Medicine, One Gustave L. Levy Place, P.O. Box 1194, New York, NY 10029, USA.
Case Rep Transplant. 2012;2012:739238. doi: 10.1155/2012/739238. Epub 2012 Oct 8.
We report a case of fulminant liver failure resulting in emergent liver transplantation following 3 weeks of nausea, vomiting, and malaise from Jamaican Vomiting Sickness. Jamaican Vomiting Sickness is caused by ingestion of the unripe arils of the Ackee fruit, its seeds and husks. It is characterized by acute gastrointestinal illness and hypoglycemia. In severe cases, central nervous system depression can occur. In previous studies, histologic sections taken from patients with Jamaican Vomiting Sickness have shown hepatotoxicity similar to that seen in Reye syndrome and/or acetaminophen toxicity. We highlight macroscopic and microscopic changes in the liver secondary to hepatoxicity of Ackee fruit versus those caused by a previously unknown sickle cell trait. We discuss the clinical variables and the synergistic hepatotoxic effect of Ackee fruit and ischemic injury from sickled red blood cells, causing massive hepatic necrosis in this patient.
我们报告了一例暴发性肝衰竭病例，该病例是在因牙买加呕吐病出现3周的恶心、呕吐和不适后紧急进行肝移植的。牙买加呕吐病是由于摄入阿开木果未成熟的假种皮、种子和果壳所致。其特征为急性胃肠道疾病和低血糖。在严重病例中，可发生中枢神经系统抑制。在先前的研究中，取自牙买加呕吐病患者的组织学切片显示出与瑞氏综合征和/或对乙酰氨基酚毒性中所见相似的肝毒性。我们着重介绍了阿开木果肝毒性继发的肝脏宏观和微观变化，以及与此前未知的镰状细胞性状所导致变化的对比。我们讨论了临床变量以及阿开木果的肝毒性与镰状红细胞缺血性损伤的协同作用，这种协同作用导致了该患者出现大规模肝坏死。
