Rapid reversal of severe hepatotoxicity from carp gallbladder poisoning with combined plasma exchange and DPMAS: A case report

Fish gallbladder ingestion is a rare but potentially life-threatening toxic exposure that may result in fulminant hepatic failure, acute kidney injury, and multiorgan dysfunction. Optimal management strategies for severe toxin-mediated hepatotoxicity remain unclear. A 61-year-old woman developed massive hepatocellular injury after ingesting the gallbladder of a dying black carp (Mylopharyngodon piceus). Laboratory testing revealed rapidly progressive and markedly elevated transaminases accompanied by early renal involvement. Given the severity and progression of organ injury, plasma exchange (PE) combined with a double plasma molecular adsorption system (DPMAS) was initiated. After two treatment sessions, liver enzymes declined dramatically, renal function stabilized without further deterioration, and the patient achieved full clinical recovery. Why should an emergency physician be aware of this?Fish gallbladder poisoning may present initially with nonspecific gastrointestinal symptoms but can rapidly progress to severe liver and kidney injury. Early recognition and timely initiation of blood purification therapy may be critical for preventing multiorgan failure and improving outcomes.