Hepatic sinusoidal obstruction syndrome caused by Gynura japonica once misdiagnosed as pancreatitis: a case report and review of literature

INTRODUCTION: Hepatic sinusoidal obstruction syndrome is a hepatic vascular disease characterized by intrahepatic congestion, liver function damage, and portal hypertension marked by edema, necrosis, and detachment of endothelial cells in the hepatic sinusoidal and interlobular veins. Pyrrolidine alkaloid-induced hepatic sinusoidal obstruction syndrome has been previously reported in Jamaica and China. CASE PRESENTATION: A 55-year-old Han Chinese female patient (with overweight), who was once misdiagnosed with pancreatitis and had no history of liver disease, except for taking Gynura japonica for 2 months, presented with abdominal pain and distension. The treatment effect was not satisfactory for pancreatitis. After a series of differential diagnoses, enhanced computed tomography led to our diagnosis of pyrrolidine alkaloid-induced hepatic sinusoidal obstruction syndrome. Transjugular intrahepatic portosystemic shunt placement was performed on the patient. The patient recovered well after the surgery. CONCLUSION: The present study aims to illustrate that hepatic sinusoidal obstruction syndrome is easily misdiagnosed. Once symptomatic treatments have no therapeutic benefit, transjugular intrahepatic portosystemic shunt is a good sequential treatment option. In addition, the present study aims to augment the existing knowledge for the diagnosis and clinical management of hepatic sinusoidal obstruction syndrome.