Veno-occlusive disease of the liver and Indian childhood cirrhosis

ABSTRACT

Cirrhosis of the liver is common in children in parts of India, especially in West Bengal and Madras, and in the West Indian island of Jamaica, where it usually occurs as a late result of 'veno-occlusive disease of the liver'. The literature concerning veno-occlusive disease is reviewed, with especial reference to its possible relation to the ingestion of plant toxins of certain 'bush teas', particularly species of Crotalaria and Senecio. The clinical and pathological features of 15 cases of Indian childhood cirrhosis (I.C.C) seen in Calcutta, West Bengal, are presented, analysed and compared with accounts in the literature. A two-stage clinical classification is suggested (1) stage of hapatomegaly, (2) stage of clinical cirrhosis. The socio-economic background of the present cases is compared with reports by previous workers. The clinical picture and morbid anatomy of veno-occlusive disease and I.C.C., as judged by the literature and the present cases, are compared and contrasted. While some cases are clinically similar, the absence in I.C.C. of the acute episode that occurs in some children with veno-occlusive disease is stressed. Hepatic venous occlusion was found in all six of the 15 children who were liver biopsied or who came to necropsy. This histological feature has been noted by some other investigators, although more workers have stressed the presence of parenchymal damage. It is noted that, in both experimental animals and in veterinary medicine, it has been shown that certain plant toxins may sometimes act on liver cells and sometimes on the hepatic veins. The possibility of a similarly varied response in children is suggested (Summary)