Successful hemoperfusion and plasma exchange in acute hepatic failure due to snake bile intoxication

Snake gallbladder is a traditional Chinese medicine that has been used for treating arthritis and detoxification for more than two thousand years. Sporadic cases of toxic hepatic and renal injury from snake gallbladder have been reported. The toxic effects are dose related and there is a high mortality rate after delayed renal failure. We present a 35 year-old man who was a hepatitis B surface antigen carrier who developed acute hepatic failure after ingestion of snake gallbladder capsules for 6 weeks. The serologic study for hepatitis C antibody, hepatitis B e antigen and hepatitis B virus-deoxyribonucleic acid (HBV-DNA) were negative. Progressively elevated liver enzymes were noted during lamivudine treatment, so blood purification therapy was done to remove possible toxins. The patient recovered after hemoperfusion preceding a series of plasma exchanges. We feel that blood purification can remove toxins and block disease progression to renal failure. In summary, we suggest that blood purification procedures should be done as soon as possible for snake gallbladder-related fulminant hepatitis due to its high mortality rate.