Citation

Sivasailam B, Kumar A, Marciniak E, Deepak J. Med. Case Rep. (Wilmington) 2019; 5(2).

Affiliation

Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.

Copyright

(Copyright © 2019, iMed Publishing)

DOI

unavailable

PMID

31633080

Abstract

[SafetyLit note: Joss paper, also known as ghost or spirit money, are sheets of special decorative paper that are burned in traditional Chinese deity or ancestor worship ceremonies during special holidays and at funerals.]

We present a case of liver failure secondary to ingestion of Joss paper. A 44-year-old female initially presented with fever, nausea and vomiting and was subsequently diagnosed with acute liver failure. Prior to presentation she had consumed 1.3 gram of acetaminophen and 800 mg of ibuprofen. Her acetaminophen level was 18 mcg/mL initially and on repeat check was <10 mcg/ml and all viral hepatology antibodies and antigens were negative. History revealed that the patient ingested a ceremonial paper, Joss paper, daily, which is typically painted with heavy metals. Her mercury level was subsequently found to be elevated to 12 ug/L. Mercury can cause depletion of glutathione (GSH) through production of reactive oxygen species. Acetaminophen metabolism requires sufficient GSH to bind to a reactive metabolite to prevent cell death and hepatic injury. Daily exposure to mercury present in the Joss paper, likely accumulated in our patient's body and allowed hepatic injury from even therapeutic doses of acetaminophen.

Language: en

Keywords

Antibodies and Antigens; Liver Failure; Viral hepatology