[Poisoning with a podophyllin-containing wart-treating tincture]

Area of Science:

• Toxicology
• Dermatology
• Internal Medicine

Background:

• Podophyllin (pod.) is a resin derived from Berberis plants, historically used in wart treatments.
• The toxic potential of podophyllin, when ingested or applied topically, is well-documented.
• Despite known risks, crude podophyllin preparations are still incorporated into over-the-counter wart tinctures.

Observation:

• A 57-year-old male with a history of depression and alcohol dependence presented with severe nausea, vomiting, and abdominal pain after ingesting podophyllin tincture.
• Initial investigations revealed significant liver enzyme elevation, elevated creatine phosphokinase and ferritin, thrombocytopenia, and leukocytosis.
• Gastroscopy demonstrated extensive mucosal necrosis in the esophagus and small intestine.

Findings:

• The patient rapidly deteriorated, developing coma, metabolic acidosis, oliguria, shock, and requiring mechanical ventilation.
• Diagnosis of podophyllin poisoning was confirmed based on clinical presentation and the known composition of the ingested wart preparation.
• Intensive supportive care led to stabilization, with extubation on day 7 and discharge on day 10.

Implications:

• Podophyllin poisoning can lead to multi-organ failure and long-term neurological deficits, such as polyneuropathy.
• This case highlights the dangers of using poorly defined herbal products containing toxic agents like podophyllin.
• Emphasizes the need for stringent regulation and public awareness regarding the risks associated with traditional remedies.