Abstract：A 7-year-old boy coughed for 7 days. His parents fed him fresh and ripe cocklebur fruit (Fructus Xanthii) once which was picked and fried by themselves (unknown dose). On the 3rd day after feeding the cocklebur fruit, the boy developed paroxysmal epigastric pain, with vomiting, anorexia, fatigue, drowsiness, and low fever. The laboratory tests showed alanine aminotransferase (ALT) 3-344-U/L, aspartate aminotransferase (AST) 3-501-U/L, serum total bilirubin (TBil) 26.5 μmol/L, direct bilirubin (DBil) 19.0 μmol/L, albumin (ALB) 32.8-g/L, and blood ammonia 120-μmol/L. On the 6th day after feeding the cocklebur fruit, the boy developed aggravated fatigue, irritability, slightly slow response, and light yellowish staining of sclera. The laboratory tests showed ALT 4-565-U/L, AST 4-335-U/L, TBil 32.9-μmol/L, DBil 23.4-μmol/L, ALB 30.2-g/L, and blood ammonia 124-μmol/L. Acute liver failure due to cocklebur fruit poisoning was considered. The boy received blood purification therapy (2 plasmapheresis and 4 days′ hemodiafiltration) and symptomatic treatments. The laboratory tests showed ALT 1-043-U/L, AST 203-U/L, TBil 22.0-μmol/L, DBil 12.3-μmol/L, ALB 39.1-g/L, and blood ammonia 36.3-μmol/L. The blood purification therapy was stopped and the symptomatic treatments was continued. The laboratory tests 2 weeks later showed ALT 24-U/L, AST 35-U/L, TBil 13.8-μmol/L, DBil 4.6-μmol/L, and ALB 47.3-g/L.
