Catharanthus roseus intoxication mimicking acute cholangitis

Area of Science:

• Herbal medicine
• Toxicology
• Pharmacology

Background:

• Catharanthus roseus, a plant native to Madagascar, is recognized for its alkaloid compounds, including those used in chemotherapy.
• Traditionally, Catharanthus roseus has been used in dried forms (flower and stalks) for medicinal purposes.
• Despite its therapeutic potential, Catharanthus roseus exhibits toxicity, leading to adverse effects.

Observation:

• A 65-year-old woman presented with symptoms suggestive of acute cholangitis, including abdominal pain and fever.
• Imaging studies ruled out common bile duct stones, prompting further investigation into alternative causes.
• The patient reported ingesting Catharanthus roseus juice for neck pain, revealing a history of herbal supplement use.

Findings:

• Laboratory results indicated leukocytosis, elevated liver enzymes, and hyperbilirubinemia, consistent with liver injury.
• The patient developed gastric ulcers, potentially linked to the alkaloid content of Catharanthus roseus.
• The patient's condition improved significantly after discontinuing the herbal extract, supporting Catharanthus roseus toxicity as the cause.

Implications:

• Catharanthus roseus toxicity can present with symptoms mimicking acute cholangitis, including fever, hepatotoxicity, cholestatic jaundice, and gastric ulcers.
• Healthcare providers must obtain comprehensive histories of herbal supplement use to ensure accurate diagnosis and management of potential toxicities.
• Increased public awareness regarding the risks associated with therapeutic herbs is essential for preventing adverse events and promoting patient safety.