Recreational Exposure during Algal Bloom in Carrasco Beach, Uruguay: A Liver Failure Case Report

VIDAL, FLAVIA; SEDAN, DANIELA; D?AGOSTINO, DANIEL; CAVALIERI, MARÍA; MULLEN, EDUARDO; PAROT VARELA, MARÍA; FLORES, CINTIA; CAIXACH, JOSEP; ANDRINOLO, DARIO

Toxins

MDPI

Lugar: Basel; Año: 2017 vol. 9

In January 2015, a 20-month-old child and her family took part in recreational activitiesat Carrasco and Malvín beaches (Montevideo, Uruguay). An intense harmful algae bloom (HAB)was developing along the coast at that time. A few hours after the last recreational exposureepisode, the family suffered gastrointestinal symptoms which were self-limited except in the child?scase, who was admitted to hospital in Uruguay with diarrhea, vomiting, fatigue, and jaundice.The patient had increased serum levels of liver enzymes and bilirubin and five days later presentedacute liver failure. She was referred to the Italian Hospital in Buenos Aires, being admitted withgrade II?III encephalopathy and hepatomegaly and requiring mechanical respiratory assistance.Serology tests for hepatitis A, B, and C, Epstein-Barr virus, and cytomegalovirus were negative.Laboratory features showed anemia, coagulopathy, and increased serum levels of ammonium, alanineaminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin. Autoimmune HepatitisType-II (AH-II) was the initial diagnosis based on a liver kidney microsomal type 1 antibodies (LKM-1)positive result, and twenty days later a liver transplant was performed. The liver histopathologyhad indicated hemorrhagic necrosis in zone 3, and cholestasis and nodular regeneration, whichwere not characteristic of AH-II. LC/ESI-HRMS (liquid chromatography electrospray ionizationhigh-resolution mass spectrometry) analysis of MCs in the explanted liver revealed the presenceof Microsytin-LR (MC-LR) (2.4 nggr􀀀1 tissue) and [D-Leu1]MC-LR (75.4 nggr􀀀1 tissue), whichconstitute a toxicological nexus and indicate a preponderant role of microcystins in the developmentof fulminant hepatitis.