The pathological diagnosis was consistent with the manifestations of acute HVOD (Figure 4).
(13) first reported the risk of HVOD caused by rooibos tea containing pyrrolidine alkaloids (PAs) in Jamaica and Barbados.
There are two main causes of HVOD: i) cytotoxic or immunosuppressive agents, such as cyclophosphamide and carmustine, and ii) agents containing PAs, such as Qianliguang, SA, and Crotalaria (19).
The clinical features of HVOD have been subdivided into 3 clinical stages: i) acute stage, in which hepatomegaly develops suddenly over 5-10 days with ascites; ii) subacute stage, in which firm hepatomegaly with or without ascites may occur spontaneously or after the acute stage and may subside or become chronic; and iii) chronic stage, in which cirrhosis occurs (23-25).
In general, the onset of symptoms in the 39 patients with HVOD who had taken SA medicinally after accidental injury or fracture in the present study occurred approximately 14 days after SA administration.
The diagnosis of HVOD is based on the patient's history of illness, clinical manifestations, imaging results, and pathological features.