Human embryotoxicity of pyrrolizidine‐containing drugs

Hepatic veno‐occlusive disease is the most frequent cause of hepatic vein obstruction in children. Only the small and medium veins are involved. The initial vascular lesion is endothelial edema, followed by phlebosclerosis and occlusion of the small vessels, leading to secondary necrosis of liver cells, progressive fibrosis, and ultimately cirrhosis. The disease was first recognized in Jamaica in 1954, and subsequently reported from other parts of the world. It arises from the ingestion of pyrrolizidine alkaloids found in various herbal medicines and in poorly winnowed wheat. Several plants have been implicated, in particular the genera Senecio, Crotalaria , and Heliotropium. More recently, similar pathologic changes have been observed after hepatic irradiation, bone marrow transplantation, and use of chemotherapeutic drugs. We report a newborn infant with fatal hepatic vaso‐occlusive disease. Pyrrolizidine alkaloids were identified in the herbal medicine bought by the mother at a pharmacy and consumed daily during the entire pregnancy.