An outbreak of hepatic veno-occlusive disease in north-western Afghanistan

Following a 2-year period of severe drought a very large number of patients with massive ascites and emaciation were observed in north-western Afghanistan. Clinicopathological study showed that these were typical cases of hepatic veno-occlusive disease. The outbreak was caused by consumption of bread made from wheat contiminated with seeds of Heliotropium plants, which were shown to contain pyrrolizidine alkaloids. Examination of 7200 inhabitants from the affected villages showed evidence of liver disease in 22.6%. Clinical improvement was observed in thirteen cases after 3 to 9 months of supportive hospital treatment, and in three cases liver biopsies showed almost complete disappearance of initial abnormalities.