{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:55:33Z","timestamp":1790751333988,"version":"4.1.0"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>\n                      A 72-year-old female with a 5-year history of type 2 diabetes presented with abdominal distension and anorexia for 2\u00a0weeks. 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\u00a0pmol\/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 \u201cTusanqi.\u201d Re-evaluation\n                      <jats:italic>via<\/jats:italic>\n                      contrast-enhanced CT and MRCP showed characteristic patterns: patchy enhancement of hepatic parenchyma (\u201cgeographic\u201d 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\u2019s 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the clinical challenge of distinguishing HSOS from abdominal malignancies. A thorough dietary\/herbal history and characteristic \u201cgeographic\u201d enhancement on imaging are pivotal for avoiding unnecessary surgical interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1833645","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:00:57Z","timestamp":1790748057000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome misdiagnosed as ovarian malignancy"],"prefix":"10.3389","volume":"17","author":[{"given":"Ke","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Gynecology, The first Affiliate Hospital of Henan Medical University","place":["Xinxiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuhua","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gynecology, The first Affiliate Hospital of Henan Medical University","place":["Xinxiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gynecology, The first Affiliate Hospital of Henan Medical University","place":["Xinxiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Gynecology, The first Affiliate Hospital of Henan Medical University","place":["Xinxiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiling","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gynecology, The first Affiliate Hospital of Henan Medical University","place":["Xinxiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangfang","family":"Hua","sequence":"additional","affiliation":[{"name":"Department of Gynecology, The first Affiliate Hospital of Henan Medical University","place":["Xinxiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Gynecology, The first Affiliate Hospital of Henan Medical University","place":["Xinxiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2023","DOI":"10.7573\/dic.2023-7-4","article-title":"Chronic liver disease and management with silymarin: an introductory review of a clinical case collection","volume":"13","author":"Angelico","year":"2024","journal-title":"Drugs Context"},{"key":"B2","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1016\/j.cld.2010.08.002","article-title":"Vascular disorders of the liver","volume":"14","author":"Crawford","year":"2010","journal-title":"Clin. 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