Case Report: Severe Hematological, Muscle and Liver Toxicity Caused by Drugs and Artichoke Infusion Interaction in an Elderly Polymedicated Patient

Publisher: Bentham Science Publishers

E-ISSN: 2212-3911|13|1|44-50

ISSN: 1574-8863

Source: Current Drug Safety, Vol.13, Iss.1, 2018-03, pp. : 44-50

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Abstract

Background: Case report, in a patient with a history of diabetes and hypertension, treatedwith metformin, gliclazide, enalapril + hydrochlorothiazide, amlodipine, aspirin and diazepam, recentlymedicated for a gouty crisis with colchicine and clonixin without improvement. Believing it could help inthe treatment of gouty crisis symptoms he took about 1.5 L of artichoke infusion (Cynara cardunculus).He felt better and did agriculture work but developed a distal muscle pain, severe anemia, standardbiochemical liver cholestasis, increase of alkaline phosphatase and marked increase of inflammatoryparameters (hyperleucocytosis) and enters in the emergency department at the hospital.

Objective: Evaluation of the cause of complaints and laboratory abnormalities and the involvement ofartichoke infusion.

Results: The prominence of the inflammatory parameters was ruled out because of exhaustiveautoimmune, infectious or para-neoplastic syndrome (blood cultures, serology, diagnostic imaging,bone marrow and bone biopsy, muscle biopsy and nerve, abdominal angiography) were carried outshowing normal results. The evaluation pointed out that the concomitant intake of artichoke infusionmay have been involved in the framework developed, since the drugs which were being administeredto/by the patient have a metabolism mainly mediated by CYP450 3A4 and 2C9 that could becompromised when these isoenzymes are inhibited by phenolic and flavonoid compounds from plants.Colchicine was one of the last drugs took that have as side effects most of the symptoms felt by patientincluding diarrhea and anemia.

Conclusion: The spontaneous and complete recovery of the patient and the negativity of researchlooking for other causes, conduce to a strong possibility of the interaction between artichoke and thedrugs in the clinical presentation of this case.