Recreational exposure during Algal Bloom in Carrasco beach, Uruguay. A liver failure case report.

DANIELA SEDAN; ANDRINOLO, D

Florianopolis

Congreso; 17th International Conference on Harmful Algae.; 2016

In January 2015, a 20 months old child and her family concurred to Carrasco beach, Montevideo, Uruguay; and maderecreational activities in the water where it was developing a severe HAB. A few hours after these activities, the familypresented gastrointestinal symptoms which were self-limiting shortly; while the girl was admitted to a Uruguayan hospitalwith diarrhea, vomiting, fatigue and jaundice. The patient had serum levels of liver enzymes and bilirubin increased. Shewas transferred to the Hospital Italiano of Buenos Aires city with acute liver failure, entering with grade II-III encephalopathy,cerebral edema and hepatomegaly; requiring mechanical respiratory assistance. The serological evaluation was negative forhepatitis viruses A, B, C, Epstein-Barr virus and cytomegalovirus. Blood tests showed anemia and increases in ammonium,AST, ALT and bilirubin serum levels.Type II autoimmune hepatitis was diagnosed by the presence of LKM-1 antibody. Patientdid not respond to the treatment and liver transplant was performed twenty days after the admission.The explanted liverhistology showed hemorrhagic necrosis in zone 3, cholestasis, portal tracts without inflammatory activities and parenchymawith nodular regeneration.HPLC/MS-MS analysis of MCs in explanted liver revealed the presence of 2,4and 75,4ng/gr liverof MC-LR and [DLeu1]MC-LR respectively. Considering that both clinical presentation and pathology are not characteristicof autoimmune hepatitis, plus the background of recreational exposure to HAB and the presence of MC-LR and [DLeu1]MCLRin explanted liver (two toxins typically present in Del Plata basin) we can conclude that exists a strong link between thesehepatotoxins and the development of fulminant hepatitis.