Male patient, 4 months old, presenting with an episode of hypotony and respiratory distress, reason why he was admitted to the hospital of origin.
During her admission, she was found to have liquid stools, symptomatic with extremities clonia lasting less than 30 seconds and notagmus, metabolic acidosis, hyperglycemia and moderate coagulopathy.
He suffered progressive hemodynamic deterioration to shock, requiring volume expansion and administration of dopamine, as well as cefoxime and clindamycin after targeting increased procalcitonin (59.1 ng/ml).
Diagnosis of septic shock of enteric origin was established in the first 24 hours at our hospital and was admitted to the Pediatric Critical Care Unit.
Personal history included late prematurity (34 weeks of gestational age), feeding with a formula of onset with good height gain, referring frequent episodes of crying, considered as colic crisis.
He received as treatment a homeopathic product containing Argentum nitricum D5, Chamomilla D1, China D3 and Cuprum aceticum D4, apple infusions purchased in pharmacy and paracetamol.
The physical examination revealed cutaneous discomfort, bleeding through puncture points and capillaritis, abdominal distension, hepatomegaly of 3 cm, irritation, hyperexcitability and discrete horizontal nystagmus.
Acute liver failure (34% with hypertransaminasemia), isolated aminotransferase [AST] 812 U/l, alanine aminotransferase [ALT] 1002 U/l), active procoagulopathy ( 22%).
He had hypoglycemia (27 mg/dl) with negative ketonemia, moderate metabolic acidosis (pH 7.25, bicarbonate 13 mmol/l, base excess -12.7 mmol/l), requiring high intravenous glucose (14 mg/kg).
Total and direct bilirubin, albumin and creatinine levels were normal.
The patient presented with fever for the first 72 hours, an increase in C-reactive protein (56 mg/l) and procalcitonin (88 ng). The patient was suspected of having received antibiotic treatment due to infectious tuberculosis.
Abdominal ultrasound showed ascites and increased peristalsis of the intestinal loops, without liver alterations.
a severe acute liver failure with initial suspicion of metabolic disorder diagnosed as such, metabolic screening was performed and treatment with N-acetylcysteine and NTBC (2-[2-methion non-steroidal anti-inflammatory drug]
Progressive neurological, hemodynamic, infectious and hepatic function improvement was observed, with 82% prothrombin activity, 148 U/l AST and 684 U/l ALT at 60 hours after admission.
The extended infectious study was negative, including hepatotropic viruses (HAV, HBV and HCV), influenzae (A, B), TORCH profile, cytochemistry and viral PCR in cerebrospinal fluid (CSF), urine and cultures (CSF).
Autoimmune liver study was also negative.
The metabolic study detected high levels of homovanyl acid, slightly elevated levels of vanillylmandelic acid and 4-hydroxyphenylpyruvic acid and mild hypoamino acid excretion.
Tandem mass, alpha-fetoprotein in blood and succinylacetone in urine were normal.
Anamnesis was reassessed, recording the intake maintained during the last two months of infusion made with two spoons of chamomile, a star anise star (Illicium verum green) 250 ml.
The Toxicological Information Service was contacted, which recommended determining the possible existence of contamination with Illicium anisatum, of known toxic alcohol effect, which justified the clinical picture by a simple procedure that suggested its presence.
The absence of turbidity suggested contamination with Illicium anisatum.
The subsequent evolution was satisfactory with complete clinical and analytical recovery of the patient.
