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Bronchiolitis Obliterans Organizing Pneumonia Following Consumption of Sauropus androgynus

Received: 6 January 2017     Accepted: 25 January 2017     Published: 28 November 2017
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Abstract

Bronchiolitis obliterans organizing pneumonia (BOOP) is a rare disorder affecting the small airways, alveoli and the walls of small bronchi. This form of lung injury involves inflammation and stiffening of lung areas with organized tissue. There are several known causes of BOOP, and several systemic disorders have BOOP as an associated primary pulmonary lesion. An outbreak of BOOP among young women has been publicly reported in Taiwan from late 1994 and onward. The source of the illness was traced to the consumption of Sauropus androgynus. Herein, we describe a case of a 28-year-old woman who developed a rapid pulmonary toxicity after drinking fresh S. androgynus purée daily for a period of two months, as an alleged regimen for weight reduction. Ga-67 citrate imaging portrayed the inflammatory status in her eyes, parotids and lungs. Pathological pattern of open-lung biopsy specimens was characteristic of BOOP. The toxicity is believed related to alkaloid papaverine contained in the plant. Bioactive principles of S. androgynus and pathogenetic mechanism underlying BOOP remain unidentified.

Published in American Journal of Internal Medicine (Volume 5, Issue 6)
DOI 10.11648/j.ajim.20170506.13
Page(s) 125-128
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

Bronchiolitis Obliterans Organizing Pneumonia, Papaverine, Sauropus androgynous, Weight Reduction

References
[1] GR Epler. Bronchiolitis obliterans organizing pneumonia, 25 years: a variety of causes, but what are the treatment options? Expert Rev Respir Med. 2011; 5 (3): 353-61.
[2] RS Lai, AA Chiang, MT Wu, JS Wang, NS Lai, LY Lu, and et al., Outbreak of bronchiolitis obliterans associated with consumption of Sauropus androgynus in Taiwan. Lancet 1996; 348 (9020): 83-5.
[3] TR Hsiue, YL Guo, KW Chen, CW Chen, CH Lee, and HY Chang. Dose-response relationship and irreversible obstructive ventilatory defect in patients with consumption of Sauropus androgynus. Chest 1998; 113 (1): 71-6.
[4] P Padmavathi, and MP Rao. Nutritive value of Sauropus androgynus leaves. Plant Foods Hum Nutr 1990 Apr; 40 (2): 107-13.
[5] AE Bender, and KS Ismail. Nutritive value and toxicity of Sauropus androgynous. The Proceedings of the Nutrition Society 1973; 32 (2): 79A-80A.
[6] H Bunawan, SN Bunawan, SN Baharum, and NM Noor. Sauropus androgynus (L.) Merr. induced bronchiolitis obliterans: From botanical studies to toxicology. Evidence-Based Complementary and Alternative Medicine 2015; 2015. doi: 10.1155/2015/714158.
[7] LP Ger, AA Chiang, RS Lai, SM Chen, and CJ Tseng. Association of Sauropus androgynus and bronchiolitis obliterans syndrome: a hospital-based case-control study. Am J Epidemiol 1997; 145 (9): 842-9.
[8] S Al-Ghanem, H Al-Jahdali, H Bamefleh, and AN Khan. Bronchiolitis obliterans organizing pneumonia: Pathogenesis, clinical features, imaging and therapy review. Ann Thorac Med 2008; 3 (2): 67-75.
[9] SF Tafti, A Fakharian, S Karimi, D Faridian-Eragh, and B Mokri. Idiopathic bronchiolitis obliterans organizing pneumonia: case review. Tanaffos 2009; 8 (2): 31-6.
[10] A Barbato, C Panizzolo, ES D'Amore, M La Rosa, and M Saetta. Bronchiolitis obliterans organizing pneumonia (BOOP) in a child with mild-to-moderate asthma: Evidence of mast cell and eosinophil recruitment in lung specimens. Pediatr Pulmonol 2001; 31 (5): 394-7.
[11] JF Cordier. Organising pneumonia. Thorax 2000; 55 (4): 318–28.
[12] B Afessa, MR Litzow, and A Tefferi. Bronchiolitis obliterans and other late onset non-infectious pulmonary complications in hematopoietic stem cell transplantation. Bone Marrow Transplant 2001; 28 (5): 425-34.
[13] DE Stover, F Milite, and M Zakowski. A newly recognized syndrome-radiation-related bronchiolitis obliterans and organizing pneumonia. A case report and literature review. Respiration 2001; 68 (5): 540-4.
[14] P Camus, and B Nemery. A novel cause for bronchiolitis obliterans organizing pneumonia: Exposure to paint aerosols in textile workshops. Eur Respir J 1998; 11 (2): 259-62.
[15] E Lappi-Blanco, Y Soini, and P Paakko. Apoptotic activity is increased in the newly formed fibromyxoid connective tissue in bronchiolitis obliterans organizing pneumonia. Lung 1999; 177 (6): 367-76.
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  • APA Style

    Rong-Hsin Yang, Shan-Fan Yao, Yum-Kung Chu. (2017). Bronchiolitis Obliterans Organizing Pneumonia Following Consumption of Sauropus androgynus. American Journal of Internal Medicine, 5(6), 125-128. https://doi.org/10.11648/j.ajim.20170506.13

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    ACS Style

    Rong-Hsin Yang; Shan-Fan Yao; Yum-Kung Chu. Bronchiolitis Obliterans Organizing Pneumonia Following Consumption of Sauropus androgynus. Am. J. Intern. Med. 2017, 5(6), 125-128. doi: 10.11648/j.ajim.20170506.13

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    AMA Style

    Rong-Hsin Yang, Shan-Fan Yao, Yum-Kung Chu. Bronchiolitis Obliterans Organizing Pneumonia Following Consumption of Sauropus androgynus. Am J Intern Med. 2017;5(6):125-128. doi: 10.11648/j.ajim.20170506.13

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  • @article{10.11648/j.ajim.20170506.13,
      author = {Rong-Hsin Yang and Shan-Fan Yao and Yum-Kung Chu},
      title = {Bronchiolitis Obliterans Organizing Pneumonia Following Consumption of Sauropus androgynus},
      journal = {American Journal of Internal Medicine},
      volume = {5},
      number = {6},
      pages = {125-128},
      doi = {10.11648/j.ajim.20170506.13},
      url = {https://doi.org/10.11648/j.ajim.20170506.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20170506.13},
      abstract = {Bronchiolitis obliterans organizing pneumonia (BOOP) is a rare disorder affecting the small airways, alveoli and the walls of small bronchi. This form of lung injury involves inflammation and stiffening of lung areas with organized tissue. There are several known causes of BOOP, and several systemic disorders have BOOP as an associated primary pulmonary lesion. An outbreak of BOOP among young women has been publicly reported in Taiwan from late 1994 and onward. The source of the illness was traced to the consumption of Sauropus androgynus. Herein, we describe a case of a 28-year-old woman who developed a rapid pulmonary toxicity after drinking fresh S. androgynus purée daily for a period of two months, as an alleged regimen for weight reduction. Ga-67 citrate imaging portrayed the inflammatory status in her eyes, parotids and lungs. Pathological pattern of open-lung biopsy specimens was characteristic of BOOP. The toxicity is believed related to alkaloid papaverine contained in the plant. Bioactive principles of S. androgynus and pathogenetic mechanism underlying BOOP remain unidentified.},
     year = {2017}
    }
    

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  • TY  - JOUR
    T1  - Bronchiolitis Obliterans Organizing Pneumonia Following Consumption of Sauropus androgynus
    AU  - Rong-Hsin Yang
    AU  - Shan-Fan Yao
    AU  - Yum-Kung Chu
    Y1  - 2017/11/28
    PY  - 2017
    N1  - https://doi.org/10.11648/j.ajim.20170506.13
    DO  - 10.11648/j.ajim.20170506.13
    T2  - American Journal of Internal Medicine
    JF  - American Journal of Internal Medicine
    JO  - American Journal of Internal Medicine
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    EP  - 128
    PB  - Science Publishing Group
    SN  - 2330-4324
    UR  - https://doi.org/10.11648/j.ajim.20170506.13
    AB  - Bronchiolitis obliterans organizing pneumonia (BOOP) is a rare disorder affecting the small airways, alveoli and the walls of small bronchi. This form of lung injury involves inflammation and stiffening of lung areas with organized tissue. There are several known causes of BOOP, and several systemic disorders have BOOP as an associated primary pulmonary lesion. An outbreak of BOOP among young women has been publicly reported in Taiwan from late 1994 and onward. The source of the illness was traced to the consumption of Sauropus androgynus. Herein, we describe a case of a 28-year-old woman who developed a rapid pulmonary toxicity after drinking fresh S. androgynus purée daily for a period of two months, as an alleged regimen for weight reduction. Ga-67 citrate imaging portrayed the inflammatory status in her eyes, parotids and lungs. Pathological pattern of open-lung biopsy specimens was characteristic of BOOP. The toxicity is believed related to alkaloid papaverine contained in the plant. Bioactive principles of S. androgynus and pathogenetic mechanism underlying BOOP remain unidentified.
    VL  - 5
    IS  - 6
    ER  - 

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Author Information
  • Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

  • Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

  • Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

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