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Topic:Toxicology

Toxicology in horses involves the study of substances that can cause adverse effects when introduced to the equine body. This field examines the sources, mechanisms, and outcomes of exposure to toxic agents, which may include plants, chemicals, drugs, and environmental toxins. Understanding toxicology is essential for identifying and managing poisoning cases in horses. Research in this area often focuses on the identification of toxic compounds, their metabolic pathways, and the clinical symptoms associated with exposure. This page compiles peer-reviewed research studies and scholarly articles that explore the detection, effects, and management of toxic substances in equine health.
Sorghum poisoning in ruminants and horses: a review.
Toxicon : official journal of the International Society on Toxinology    April 24, 2025   Volume 261 108375 doi: 10.1016/j.toxicon.2025.108375
Vasconcelos de Sousa AL, Riet-Correa F, Botelho de Castro M, Machado M.We reviewed the history, epidemiology, clinical signs, pathology, pathogenesis, treatment, control, and prophylaxis of Sorghum poisoning in livestock. Economic losses in the livestock industry associated with sorghum have been reported since the 19th century. Hyperacute/acute poisoning associated with cyanide (HCN) or nitrate/nitrite frequently occurs in ruminants that consume high quantities of growth and regrowth sorghum after drought, followed by rainfall, respectively. Chronic cystitis-ataxia syndrome primarily affects horses after weeks of grazing on sorghum pastures, while congenital art...
Assessing Cadmium Levels in Horses Imported from the European Union and Slaughtered in Italy.
Veterinaria italiana    April 14, 2025   Volume 61, Issue 2 doi: 10.12834/VetIt.3692.31893.2
Dimuccio MM, Ceci E, Bonerba E, Celentano FE, De Marzo P, Leone R, Sportelli S, Bozzo G.The aim of this study was to evaluate cadmium (Cd) concentrations in horses imported from various European Union countries and slaughtered in Italy. In addition, we assessed the potential correlation between Cd levels in tissues and organs, and Cd-related gross and histological lesions. The animals were divided into six groups based on age and geographical origin. Among the 430 animals examined, gross renal lesions were observed in only two kidney samples from Polish horses, which also had the highest Cd concentrations: 9.1 mg/kg w/w and 8.23 mg/kg w/w, respectively. Further histological a...
Morphine and codeine in racing horse feed: is there reason for concern?
Arhiv za higijenu rada i toksikologiju    March 31, 2025   Volume 76, Issue 1 60-66 doi: 10.2478/aiht-2025-76-3888
Karačonji IB, Jelača T, Jurič A, Vrdoljak AL.Opiates such as morphine and codeine are substances often misused to improve the performance of racing horses during competitions and are therefore on the International Federation for Equestrian Sports' list of prohibited substances. However, a positive antidoping test may be due to the consumption of feed (mainly lucerne or oats) contaminated by opium poppy containing the alkaloids morphine and codeine. In order to determine whether a positive antidoping test is the result of an intentional abuse of opiates or consumption of feed contaminated by poppies, we optimised conditions for the extrac...
Concentrations of arsenic (As), cadmium (Cd) and lead (Pb) in blood, hair and semen of stallions in Finland.
Journal of trace elements in medicine and biology : organ of the Society for Minerals and Trace Elements (GMS)    March 14, 2025   Volume 89 127633 doi: 10.1016/j.jtemb.2025.127633
Oztas T, Akar M, Virkanen J, Beier C, Goericke-Pesch S, Peltoniemi O, Kareskoski M, Björkman S.Heavy metal contamination poses significant environmental and health risks to both humans and animals. This study investigates the concentrations of arsenic (As), cadmium (Cd), and lead (Pb) in blood, hair, and semen samples collected from 16 breeding stallions in Western Finland to assess whether concentrations in hair and serum samples represent concentrations in semen. The analysis was conducted using an inductively coupled plasma mass spectrometry (ICP-MS) system. Results showed that hair samples exhibited the highest concentrations of heavy metals, particularly Pb and As, while semen show...
Equine upper airway laser surgery generates plumes containing hazardous components.
American journal of veterinary research    February 6, 2025   1-6 doi: 10.2460/ajvr.24.11.0338
Sholty KA, Hecobian A, Sullivan AP, Collett JL, Koch DW, Hackett ES.To evaluate plume composition during simulated diode laser equine upper airway surgery. Unassigned: A 980-nm diode laser fiber was applied in continuous-wave mode in contact with laryngeal and pharyngeal tissues of 6 equine cadaver heads, and resultant plumes were collected for analysis. Measured parameters included the real-time concentration of particulate matter under the size of 2.5 μm (PM2.5), organic carbon (OC), elemental carbon (EC), and volatile organic compounds (VOCs). Unassigned: Visible smoke was encountered during surgical laser application and plume collection. Diode laser medi...
Nonexertional Rhabdomyolysis.
The Veterinary clinics of North America. Equine practice    January 31, 2025   Volume 41, Issue 1 95-110 doi: 10.1016/j.cveq.2024.11.002
Valberg SJ.Although horses most commonly develop exertional rhabdomyolysis, there are numerous causes for nonexertional rhabdomyolysis (nonER) that pose a serious health threat to horses. Their etiologies can be broadly categorized as toxic, genetic, inflammatory/infectious, nutritional, and traumatic and a variety of diagnostic tests are available to discern among them. This study discusses causes of nonER as well as diagnostics and treatments that are specific to each etiology. General treatment of acute rhabdomyolysis is covered in detail in the study in this issue on sporadic and recurrent exertional...
Screening analysis of doping agents in horse urine and plasma with dilute and shoot using liquid chromatography high resolution mass spectrometry.
The Analyst    January 23, 2025   doi: 10.1039/d4an01501k
Göktaş EF, Kabil E, Söylemez Yeşilçimen E, Dirikolu L.Various technical methodologies are required to accurately detect substances of different chemical and pharmacological properties in biological samples, which are increasing in number and variety daily. Therefore, laboratories where many samples and different factors are analyzed simultaneously need methods with easy sample preparation, short analysis times and low analysis costs. In this study, the objective was to scan substances susceptible to chemical degradation, amenable to analysis without hydrolysis, and exhibiting short-term stability by employing a straightforward, expeditious, and c...
Ethylene glycol toxicosis in 39 sport horses following ingestion of contaminated water: A case report.
Journal of equine veterinary science    January 2, 2025   Volume 145 105343 doi: 10.1016/j.jevs.2025.105343
Daradics Z, Bungărdean D, Lupșan AF, Popescu M, Bulmez O, Ciulu-Angelescu V, Chelaru VF, Morar I, Mircean M, Cătoi C, Tripon MA, Crecan CM.Ethylene glycol toxicosis is a common occurrence in dogs and cats but has been reported in other species as well. Up to date, only one case of ethylene glycol toxicosis has been described in horses, and specific guidelines for treating ethylene glycol intoxication in this species are not available. Here we describe the case of 39 sport horses that ingested water contaminated with ethylene glycol. The main clinical sign was apathy, but more severely affected individuals also developed abdominal pain and laminitis. Treatment was initiated around 24 h after the exposure, using ethanol as an antid...
Doping Control Analysis of Methylsulfonylmethane in Horses.
Drug testing and analysis    December 21, 2024   doi: 10.1002/dta.3844
Wong JKY, Choi TLS, Wong COL, Curl P, Wan TSM, Ho ENM.Methylsulfonylmethane (MSM), also known as dimethyl sulfone, is a naturally occurring sulphur-containing compound that can be found in plants, animals and humans. MSM can also be a metabolite of dimethyl sulfoxide (DMSO). Due to their anti-inflammatory and analgesic effects, both MSM and DMSO are prohibited substances in horseracing. As both substances are naturally occurring, their misuse in horses is controlled by International Residue Limits (IRL) of 1200 and 15 μg/mL, respectively, in horse urine as established by the International Federation of Horseracing Authorities. The elimination ...
Electrochemotherapy with bleomycin for bilateral ocular squamous cell carcinoma in a horse.
Veterinary ophthalmology    December 16, 2024   doi: 10.1111/vop.13310
Larsen MME, Eriksson A, Impellizeri JA.To describe the procedure and outcome of electrochemotherapy (ECT) with bleomycin as a first-line treatment for bilateral ocular surface squamous neoplasia (OSSN) in the eye of a horse. Methods: A client-owned 5-year-old Haflinger gelding with limbal-conjunctival squamous cell carcinoma. Methods: During general and local anesthesia, injection of bleomycin in the ocular tumor was followed by electroporation, applied with a 15 mm needle electrode, needles held parallel to the ocular surface. Results: Treatment with ECT resulted in therapeutic electric pulses and complete tumor response with no...
An ongoing concern: 20 years of research on equine atypical myopathy.
The Veterinary record    December 13, 2024   Volume 195, Issue 12 e5039 doi: 10.1002/vetr.5039
François AC, Renaud B, Kruse CJ, Marcillaud-Pitel C, Votion DM.Anne-Christine François, Benoît Renaud, Caroline-Julia Kruse, Christel Marcillaud-Pitel and Dominique-Marie Votion of the Atypical Myopathy Alert Group discuss insights from 20 years of research and surveillance on equine atypical myopathy.
Robinia pseudoacacia poisoning in two horses: A case report.
Veterinarni medicina    November 21, 2024   Volume 69, Issue 11 395-400 doi: 10.17221/55/2024-VETMED
Novotna T, Samonilova E, Klan J, Frgelecova L, Mala A, Svobodova Z, Drabkova Z.This case report describes the poisoning of two mares from the same paddock with Robinia pseudoacacia (Black locust) bark. The poisoning manifested itself by the sudden onset of weakness and fever with transient improvement after the administration of non-steroidal anti-inflammatory drugs and fluids. After the initial stabilisation, the mares were left unattended overnight. One of them was found dead in the morning. The surviving mare developed colic and severe encephalopathy and had to be referred to the clinic. Blood tests revealed severe hyperammonaemia. After four days of symptomatic treat...
Feed-induced hypersalivation in horses from Austria, Germany and Switzerland.
Equine veterinary journal    November 15, 2024   Volume 57, Issue 4 1035-1043 doi: 10.1111/evj.14433
Böswald LF, Gottschalk C, Kaltner F, Merk J, Schwaiger K, Kienzle E.While previous reports come mostly from the southern Americas, several outbreaks of hypersalivation in horses were observed in Middle Europe from 2016 to 2018. Objective: To describe feed-induced hypersalivation in European horses. Methods: Analysis of feedstuffs. Methods: Veterinarians and horse or stable owners were encouraged to submit feedstuffs from case outbreaks of hypersalivation in which, infectious diseases or other systemic causes of the syndrome were ruled out and intoxication was suspected. Feedstuff analysis was performed, including gross examination, microscopic analysis of fine...
Safety and efficacy of a feed additive consisting of an essential oil derived from the flowering stems of Salvia sclarea L. (clary sage oil) for use in all animal species (FEFANA asbl).
EFSA journal. European Food Safety Authority    November 14, 2024   Volume 22, Issue 11 e9016 doi: 10.2903/j.efsa.2024.9016
Villa RE, Azimonti G, Bonos E, Christensen H, Durjava M, Dusemund B, Gehring R, Glandorf B, Kouba M, López-Alonso M, Marcon F, Nebbia C, Pechová A....Following a request from the European Commission, EFSA was asked to deliver a scientific opinion on the safety and efficacy of an essential oil from the fresh or dried flowering stems of L. (clary sage oil) when used as a sensory additive in feed and in water for drinking for all animal species. The EFSA Panel on Additives and Products or Substances used in Animal Feed (FEEDAP) concluded that the additive under assessment is considered safe up to the maximum use level in complete feed of 15 mg/kg for veal calves (milk replacers), cattle for fattening, sheep/goats, 10 mg/kg for horses, 20 mg/k...
Ocular toxicity, distribution, and shedding of intravitreal AAV-eqIL-10 in horses.
Molecular therapy. Methods & clinical development    October 28, 2024   Volume 32, Issue 4 101360 doi: 10.1016/j.omtm.2024.101360
Young K, Hasegawa T, Vridhachalam N, Henderson N, Salmon JH, McCall TF, Hirsch ML, Gilger BC.Non-infectious uveitis (NIU) is a painful recurrent disease affecting 2%-5% of horses. Current treatments require frequent administration with associated adverse events. In a previous study, intravitreal (IVT) adeno-associated virus (AAV) harboring equine interleukin-10 (eqIL-10) cDNA inhibited experimental uveitis in rats. The goal of this study was to evaluate the ocular tolerability, vector genome (vg) distribution, and vector shedding following an IVT injection of AAV8-eqIL-10 in normal horses with the hypothesis that it would be well tolerated in a dose-dependent manner in horses. Inject...
Administration Route Differentiation of Altrenogest via the Metabolomic LC-HRMS Analysis of Equine Urine.
Molecules (Basel, Switzerland)    October 22, 2024   Volume 29, Issue 21 4988 doi: 10.3390/molecules29214988
Elbourne M, Keledjian J, Cawley A, Fu S.Altrenogest, also known as allyltrenbolone, is a synthetic form of progesterone used therapeutically to suppress unwanted symptoms of estrus in female horses. Altrenogest affects the system by decreasing levels of endogenous gonadotrophin and luteinizing and follicle-stimulating hormones, which in turn decreases estrogen and mimics the increase of progesterone production. This results in more manageable mares for training and competition alongside male horses while improving the workplace safety of riders and handlers. However, when altrenogest is administered, prohibited steroid impurities su...
Clinical and pathological findings of Africanized bee (Apis mellifera) envenomation in horses.
Toxicon : official journal of the International Society on Toxinology    October 19, 2024   Volume 251 108136 doi: 10.1016/j.toxicon.2024.108136
Costa Kamura BD, Albertino LG, Cavallari RR, Queiroz de Souza L, Rodrigues LT, Barros de Sousa Pereira I, Rocha NS, Takahira RK, Briscola Pereira WA....Africanized crossbred bees (Apis mellifera) originated in Brazil in 1957, and since then, the number of accidents involving humans and animals has significantly increased. Although they are considered clinical emergencies, there are few reports describing the clinical and pathological aspects of bee envenomation in horses. In this context, this report aims to describe the clinical and pathological features of bee toxicity after massive bee envenomation in three horses. The horses were referred to the veterinary hospital the day following the attack, and after clinical and laboratory examinatio...
Reimagining stallion sperm conservation: Combating carbotoxicity through pyruvate-induced Warburg effect to enhance sperm longevity and function.
Journal of equine veterinary science    October 9, 2024   Volume 143 105204 doi: 10.1016/j.jevs.2024.105204
Peña FJ, Martín-Cano FE, Becerro-Rey L, da Silva-Álvarez E, Gaitskell-Phillips G, Ortega-Ferrusola C, Aparicio IM, Gil MC.Although stallion spermatozoa are now recognized as highly dependent on oxidative phosphorylation for ATP production in the mitochondria, most extenders in use contain supraphysiological concentrations of glucose as the main energy source. While the toxicity of cryoprotectants has been well documented in the literature, the potential toxicity of excessive glucose in extenders is largely ignored. However, the toxicity of excess glucose, known as "carbotoxicity", is well-established in many areas of medicine. In this paper, we review the basic aspects of stallion spermatozoa metabolism, focusing...
Senecio ovatus poisoning in a horse – A case report.
Veterinarni medicina    September 22, 2024   Volume 69, Issue 9 329-336 doi: 10.17221/37/2024-VETMED
Kopecka A, Novotna T, Svobodova Z, Drabkova Z.This study describes a case of poisoning by pyrrolizidine alkaloids in a horse. To the best of the author's knowledge, this is the first confirmed case of Senecio ovatus poisoning. A six-year-old 450-kg Irish cob mare was presented to the Equine Clinic of the University of Veterinary Sciences Brno (Czechia) with symptoms of hepatic encephalopathy, which progressively worsened with time despite intensive therapy and led to euthanasia. A complex diagnostic and therapeutic approach including the post-mortem patoanatomical and histopathological examination is described here. Regar...
Doping Control Analysis of Perfluorocarbons in Equine Plasma by Headspace Gas Chromatography-Tandem Mass Spectrometry.
Drug testing and analysis    September 18, 2024   Volume 17, Issue 7 1011-1027 doi: 10.1002/dta.3801
Kong FKW, Wong ASY, Cheung RKK, Wan TSM, Ho ENM.In order to control the potential misuse of perfluorocarbons as an oxygen carrier in equine sports, a simple and sensitive method for detecting perfluorocarbons in equine plasma by gas chromatography/tandem mass spectrometry using negative chemical ionization with methane as reagent gas has been developed and fully validated. The method covers seven perfluorocarbons, which are the active components in blood substitute products, and shows good sensitivity and robustness. Limits of detection as low as 0.01 ng/mL could be achieved by the method. To the best of our knowledge, this is the first r...
Chemotherapeutics in Equine Practice.
The Veterinary clinics of North America. Equine practice    August 17, 2024   Volume 40, Issue 3 387-395 doi: 10.1016/j.cveq.2024.07.004
Malalana F.Chemotherapy is the treatment of cancerous cells through the use of cytotoxic drugs. Whilst the use of systemic (intravenous) chemotherapy in equine practice is generally limited to the management of lymphoma, cytotoxic drugs are commonly used in the treatment of accessible skin tumors, either by topical application in the form of ointments or injected intralesionally. These drugs should be employed with caution due to the risk of serious adverse effects. In addition, extreme caution should be followed when preparing, handling, administering, and disposing them, due to their carcinogenic, muta...
Safety and efficacy of a feed additive consisting of an essential oil obtained from the fruit of Apium graveolens L. (celery seed oil) for all animal species (FEFANA asbl).
EFSA journal. European Food Safety Authority    July 25, 2024   Volume 22, Issue 7 e8907 doi: 10.2903/j.efsa.2024.8907
Bampidis V, Azimonti G, Bastos ML, Christensen H, Durjava M, Kouba M, López-Alonso M, López Puente S, Marcon F, Mayo B, Pechová A, Petkova M....Following a request from the European Commission, EFSA was asked to deliver a scientific opinion on the safety and efficacy of an essential oil obtained from the fruit of L. (celery seed oil), when used as a sensory additive in feed and water for drinking for all animal species. The EFSA Panel on Additives and Products or Substances used in Animal Feed (FEEDAP) Panel concluded that the use of celery seed oil is of no concern up to the following concentrations in complete feed: 1.6 mg/kg for chickens for fattening, 2.3 mg/kg for laying hens, 2.1 mg/kg for turkeys for fattening, 2.8 mg/kg for p...
Large-scale study of blood markers in equine atypical myopathy reveals subclinical poisoning and advances in diagnostic and prognostic criteria.
Environmental toxicology and pharmacology    July 18, 2024   Volume 110 104515 doi: 10.1016/j.etap.2024.104515
Renaud B, Kruse CJ, François AC, Cesarini C, van Loon G, Palmers K, Boemer F, Luis G, Gustin P, Votion DM.Equine atypical myopathy (AM) is a severe rhabdomyolysis syndrome primarily caused by hypoglycin A (HGA) and methylenecyclopropylglycine protoxins. This study aimed to refine diagnostic and prognostic criteria for AM while exploring apparently healthy cograzers. Blood samples from 263 horses, including AM cases (n= 95), cograzers (n= 73), colic horses (n= 19), and controls (n= 76), were analyzed for HGA, its toxic metabolite, and acylcarnitines profile. Diseased horses exhibited alterations in acylcarnitines that strongly distinguished them from controls and colic horses. Regression analyses i...
Selenium deposition in an atypically disintegrated hoof wall in a Thoroughbred racehorse with alkali disease: Proof by energy-dispersive X-ray fluorescence analysis.
Journal of comparative pathology    July 15, 2024   Volume 212 51-55 doi: 10.1016/j.jcpa.2024.06.002
Kuwano A, Ueno T, Katsurashima Y, Tateno O, Saitoh S.From summer 2018 to summer 2019, several Thoroughbred racehorses held at the Miho Training Centre of the Japan Racing Association inadvertently ingested excessive amounts of sodium selenite, resulting in typical chronic selenium (Se) poisoning - the so-called alkali disease. The typical abnormality was a hoof wall disorder with a circumferentially deep ring and/or transverse hoof wall cracks parallel to the coronet on all feet and appearing after excessive ingestion. One affected Thoroughbred male was unique in that all the hooves had a rough surface with a very fragile hoof wall, but no wall ...
Safety and efficacy of a feed additive consisting of sodium ferrocyanide and potassium ferrocyanide for all animal species (Eusalt a.i.s.b.l.).
EFSA journal. European Food Safety Authority    July 12, 2024   Volume 22, Issue 7 e8851 doi: 10.2903/j.efsa.2024.8851
Bampidis V, Azimonti G, Bastos ML, Christensen H, Durjava M, Dusemund B, Kouba M, López-Alonso M, López Puente S, Marcon F, Mayo B, Pechová A....Following a request from the European Commission, EFSA was asked to deliver a scientific opinion on the safety and efficacy of sodium ferrocyanide and potassium ferrocyanide as technological feed additives for all animal species. In its previous opinion on the safety and efficacy of the additives, the FEEDAP Panel concluded that the use of sodium ferrocyanide and potassium ferrocyanide is safe, when added to sodium chloride at a maximum content of 80 mg ferrocyanide anions (anhydrous)/kg for turkeys for fattening and laying hens and other laying/breeding birds, all porcine species and categori...
Equine Pergolide Toxicity: A Case Series.
Cureus    July 10, 2024   Volume 16, Issue 7 e64265 doi: 10.7759/cureus.64265
Ebeling-Koning NE, Fowler JT, DelBianco JD, Surmaitis RM.Veterinary medication exposure may result in human toxicity, with approximately 6,000 exposures to veterinary-only medications reported to poison centers in 2022. There is a paucity of literature on the management of poisoned patients secondary to pharmaceuticals intended for equine use. Pergolide is a dopamine and serotonin receptor agonist and is currently approved to treat equine Cushing's disease. It was previously approved in the United States (US) to treat Parkinson's disease in humans; however, it was withdrawn from the market in 2007 due to its association with valvular heart disease....
Broad-spectrum and sensitive screening of more than 1000 compounds in equine urine using liquid chromatography/high-resolution mass spectrometry.
Rapid communications in mass spectrometry : RCM    July 1, 2024   Volume 38, Issue 17 e9856 doi: 10.1002/rcm.9856
Uchida T, Kisugi T, Ishii H, Yamada M, Kinoshita K, Leung GN.To uphold the integrity of horseracing and equestrian sports, it is critical for an equine doping control laboratory to develop a comprehensive screening method to cover a wide range of target substances at the required detection levels in equine urine. Methods: The procedure involved the enzymatic hydrolysis of 3 mL urine samples followed by solid-phase extraction using HF Bond Elut C18 cartridge. The resulting extracts were then separated on a C18 reversed-phase column and analyzed using liquid chromatography/high-resolution mass spectrometry (LC/HRMS) in both electrospray ionization positiv...
Hair loss and endocrine dermatosis on horses raised in a Mimosa pudica var. unijuga-invaded area.
Toxicon : official journal of the International Society on Toxinology    July 1, 2024   Volume 247 107844 doi: 10.1016/j.toxicon.2024.107844
Machado M, Queiroz-Machado CRR, Queiroz F, Gardner DR, Riet-Correa F.A Mimosa pudica var. unijuga-associated toxicity affecting horses occurred in Araguari, Triângulo Mineiro, Southeast Brazil. Affected horses had gradual hair loss of the mane and tail and endocrine dermatosis after grazing for three months during the dry season on a paddock invaded by the plant. The main histological lesions include compact ortho-keratotic hyperkeratosis and numerous flame follicles. Toxicological analysis by HPLC-UV demonstrated 0.8 mg/g of mimosine in the leaves.
Suspected envenomation by the common European adder (Vipera berus berus) in 28 horses in Finland.
Journal of equine veterinary science    July 1, 2024   Volume 140 105145 doi: 10.1016/j.jevs.2024.105145
Leppänen V, Mykkänen A.Vipera berus berus is the only venomous snake present in the Nordic countries and cases of envenomation in horses are reported during the warmer months. Little is known about the presentation, treatment and survival of horses with common European adder envenomation. Clinical and laboratory findings, treatment and outcome are reported for 28 horses admitted to Helsinki University Equine Hospital in 2008-2023 due to suspicion of snake bite. Eleven of these horses received antivenom treatment. Other common treatments included non-steroidal anti-inflammatories (22/28), antimicrobials (19/28), intr...
Computed tomographic angiography of a presumed acquired transhepatic portosystemic shunt in a miniature horse filly. Iranmanesh M, Sato AF, Tenney W, Brinker EJ, Cortez K, Mazan M.A 1-year-old Miniature Horse filly was presented for chronic lethargy and hyporexia. Elevated liver enzymes, bile acids, and ammonia were noted on bloodwork. The primary differential diagnosis was a portosystemic shunt (PSS). Three-phase computed tomographic angiography findings were consistent with a transhepatic portosystemic shunt. Percutaneous liver biopsy confirmed severe diffuse hepatic changes, most likely due to chronic pyrrolizidine alkaloid toxicosis, and medical management was elected. Based on an extensive literature review, this is the first report of a transhepatic portosystemic ...