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Case Reports
. 2022 Mar 22;15(3):e247867.
doi: 10.1136/bcr-2021-247867.

Toxic hepatitis-associated aplastic anaemia after dual homeopathic remedies and Gymnema sylvestre use

Cyriac Abby Philips  1 , Arif Hussain Theruvath  2 , Resmi Ravindran  2
Affiliations
Case Reports

Toxic hepatitis-associated aplastic anaemia after dual homeopathic remedies and Gymnema sylvestre use

Cyriac Abby Philips et al. BMJ Case Rep. .

Abstract

Hepatitis-associated aplastic anaemia (HAAA) is a rare condition characterised by onset of acute hepatitis which is followed by development of severe pancytopenia due to bone marrow failure within 6 months. This syndrome can be precipitated by acute viral infections, but the aetiology remains unknown in the majority. Drug-induced HAAA is extremely rare and has been reported with nutritional and dietary supplements in current literature. We report the first cases of ayurvedic herbal and homeopathic remedies-associated HAAA in two patients which proved fatal in both. Evaluation of patients with acute hepatitis and severe pancytopenia must include a detailed evaluation for complementary and alternative medicine use.

Keywords: drugs and medicines; gastrointestinal system; hepatitis other; liver disease; toxicology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Retrieved homeopathic remedies (A) and Gymnema sylvestre powder (B) from patients who developed acute hepatitis-associated aplastic anaemia.
Figure 2
Figure 2
Liver histopathology—showing areas of lobular disarray, predominant lobular inflammation (A, H&E 10×); lymphocytic inflammation of the lobular and perisinusoidal areas (B, H&E 40×); hepatocyte fallout (cytolysis) and necrosis in zone 3 (C, H&E, 40×); spotty necrosis and lobular disarray in second patient (D, H&E 10×); intracanalicular (E) and hepatocellular cholestasis (F) noted in second patient (H&E, 100×); bone marrow biopsy showing hypocellularity and trilineage hypoplasia without haemophagocytosis or fibrosis, consistent with aplastic anaemia.
See this image and copyright information in PMC

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