Nodular regenerative hyperplasia of the liver associated with the toxic oil syndrome: Report of five cases

Abstract

Nodular regenerative hyperplasia of the liver developed in five patients who had the toxic oil syndrome caused by ingestion of adulterated cooking oil. This hepatic complication was detected from 19 to 37 months (mean-2.5 years) after the onset of the toxic oil syndrome. Nodular regenerative hyperplasia was asymptomatic, although all patients had persistently abnormal liver function. Hepatomegaly was present in four cases, mild jaundice in three and signs of portal hypertension in two. Pathogenesis of nodular regenerative hyperplasia in toxic oil syndrome is unknown, but probably microcirculatory disturbances within the liver might have played a role. Fibrosis in Zone 3, sinusoidal dilatation and occasionally intralobular hemorrhage were seen in three cases; in one of them, characteristic lesions of veno-occlusive disease were also present. In another case, endarteritis changes of hepatic arterioles were evident.

Orthotopic Liver Transplantation for Idiopathic Portal Hypertension: Indications and Outcome

“…One of the most striking features was the absence of any underlying disease known to be associated with IPH, such as connective tissue diseases, auto-immune disorders or hematological malignancies (18)(19)(20)(21)(22)(23)(24). There was no evidence of toxic liver injury, including azathioprine intake or exposure to toxic oil (22,(25)(26)(27)(28)(29).…”

Sinusoidal obstruction syndrome and nodular regenerative hyperplasia are frequent oxaliplatin‐associated liver lesions and partially prevented by bevacizumab in patients with hepatic colorectal metastasis

“…In the short term, we observed the persistence and even the progression of SOS and NRH in the setting of two‐stage hepatectomies, 10 suggesting that there is no advantage in delaying an operation that is otherwise well timed in terms of tumour response to chemotherapy. In the long term, the issue is more open: analogy with the settings of toxic oil syndrome, in which NRH and portal hypertension were noted 2.5 years after consuming the oil 44 azathioprine and 6‐thioguanine, suggests that the changes are not reversible; and we observed persistent SOS, NRH and even fibrosis several months after chemotherapy had been interrupted in some patients undergoing repeat hepatectomies for recurrence 11 . However, we have recently operated on patients in whom severe OX‐related changes present at the first operation had reverted to normal at the second hepatectomy.…”

Treatment of nasopharyngeal carcinoma in children and adolescents

“…Five cases of NRH associated with toxic oil syndrome have been reported 19. In 1981, in northern Spain, the ingestion of contaminated olive oil caused a syndrome characterized by severe myalgias, pulmonary infiltrates, and eosinophilia.…”