Fulminant Hepatitis Caused by High Macadamia Nuts Intake: A CASE REPORT

A 38-year-old woman developed nausea and fatigue the day after eating a large amount of macadamia nuts. She was diagnosed with acute hepatitis at a nearby facility. After hospitalization, her liver function worsened. She tested negative for various viral markers and autoantibodies, and no organic abnormality was found on imaging. She was transferred to our hospital, where steroid pulse therapy was initiated. Due to the significantly increased prothrombin time and loss of consciousness, she was diagnosed with subacute fulminant hepatitis. Plasma exchange and continuous slow hemodiafiltration were performed, and the liver function normalized after six plasma exchange sessions. A liver biopsy was performed after her condition improved, and the pathology revealed nonspecific hepatitis. The result of a macadamia nut DLST was strongly positive. She continued to progress uneventfully after discontinuation of the treatment and was discharged on the 46th day of hospitalization. We report a very rare case of fulminant hepatitis resulting from food poisoning.