Case Report: Pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome misdiagnosed as ovarian malignancy
- 1Department of Gynecology, The first Affiliate Hospital of Henan Medical University , ,
Abstract
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.
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BibTeX
@article{wang2026case,
title = {{Case Report: Pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome misdiagnosed as ovarian malignancy}},
author = {Ke Wang and Shuhua Wang and Yijuan Wang and Jing Lu and Huiling Wang and Fangfang Hua and Jun Yang},
journal = {Frontiers in pharmacology},
year = {2026},
month = sep,
doi = {10.3389/fphar.2026.1833645},
url = {https://europepmc.org/article/PMC/PMC13661801},
note = {CC BY},
}
RIS
TY - JOUR
TI - Case Report: Pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome misdiagnosed as ovarian malignancy
AU - Ke Wang
AU - Shuhua Wang
AU - Yijuan Wang
AU - Jing Lu
AU - Huiling Wang
AU - Fangfang Hua
AU - Jun Yang
PY - 2026
DA - 2026/09/30
JO - Frontiers in pharmacology
DO - 10.3389/fphar.2026.1833645
UR - https://europepmc.org/article/PMC/PMC13661801
AB - 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.
SN - 1663-9812
ER -