A Case of Podophyllum Poisoning with Involvement of the Nervous System

Abstract

There are a number of toxic substances which, after absorption via one route or another, may lead to the development of a disturbance of function in the nervous system with or without ensuing structural damage.Quite often the peripheral nerves appear to be principally involved, this resulting in the production of a more or less symmetrical type of peripheral neuropathy; moreover, in such cases there may be severe structural changes, with the result that recovery of function, although tending ultimately to be complete, may be longdelayed. There may also be involvement of the central nervous system by the toxic action of the ingested substance, and, although the exact modus operandi may not be known, it seems likely that in many such cases the upset of function in the nervous system may well be the result of interferenCe with various enzyme systems.The following case report is of a patient who developed a fairly severe disturbance of central and peripheral nervous function after taking an overdose of a podophyllum extract by mouth. We have not been able to find a similar case in the literature. For this reason, and also because the effects of this substance upon living tissue have recently been the subject of investigation, we felt that the case should be placed on record.Case History A married woman aged 25, believing herself to be pregnant, drank 1 fl. oz. (28.4 ml.) of a proprietary concentrated alcoholic extract of American podophyllum root (P. peltatirn) one evening on the advice of a friend. There were apparently no immediate ill effects, but the next day she began to vomit repeatedly, becoming confused and finally comatose within 24 hours. The same evening vaginal haemorrhage also supervened and she was transferred to hospital as a gynaecological emergency. On admission she was found to be confused, noisy, and restless, hiccuping, yawning, and retching in turn. A bruise was present over the right eye, but her colour was good and her tongue moist and clean. The ocular fundi and pupils were normal, the knee-jerks were present and equal, but the abdominal reflexes were absent and the plantar responses extensor. The pulse rate was 60 a minute, the temperature 97.8' F. (36.6' C.), and the blood pressure 120/80 mm. Hg. On clinical examination no abnormalities could be detected in the cardiovascular, respiratory. or gastro-intestinal systems, and, although a gynaecological examination revealed the presence of a blood-stained watery discharge from the vagina, the cervix and vagina itself were normal in appearance, there being no evidence of enlargement or abnormality of the uterus.A provisionial diagnosis of poisoning was made in view of the clinical history, and gastric lavage was performed shortly afterwards. From the time of admission the patient was able to take fluids by mouth, and a marked lessening in the severitv of her confusional state had occurred two days after admission. It was recorded at this stage that the tendon reflexes had become sluggish, while a lumbar ptinctuire revealed a clear cerebrospinal ...

Medical memoranda. Toxic effect of podophyllum application in pregnancy.

“…Severe peripheral neuropathy together with an acute confusional state leading to coma was recorded by Clark and Parsonage (1957) in a young woman who drank 2-8 g of podophyllum resin believing herself to be pregnant. She had made a substantial recovery at six months but some neurological deficit persisted 16 months after ingestion.…”

Podophyllotoxin Intoxication: Toxic Effect of Bajiaolian in Herbal Therapeutics

“…The literature contains reports of podophyllotoxin poisoning resulting from topical use or accidental ingestions of podophyllum resin. [5][6][7][8][9][10][11][12][13][14][15][16][17] However, there are no documented reports of poisoning from drinking infusions made from crude blends containing Bajiaolian root. The case reports that follow describe the clinical manifestations seen and then discuss some of the implications.…”

Sensory Neuropathy due to Bajiaolian (Podophyllotoxin) Intoxication

“…This toxin may affect the nervous system, bone marrow, liver, kidneys and gastrointestinal system [1,2,4,5]. In our case, severe nausea, vomiting and diarrhea occurred immediately after ingestion of this herb drug containing podophyllotoxin, then progressive distal limb numbness developed.…”