Acute Effusive Pericarditis due to Horse Chestnut Consumption

Abstract

Patient: Male, 32Final Diagnosis: Pericardial effusion related to the consumption of herbal productSymptoms: DyspneaMedication: Horse chestnut (Aesculus hippocastanum L)Clinical Procedure: Pericardial and pleural effusions were drained through a pericardiopleural windowSpecialty: CardiologyObjective:Unusual clinical courseBackground:There are many well-known causes of pericardial effusion, such as cancer metastasis, bacterial or viral pericarditis, and uremic pericarditis; however, no reports exist in the literature demonstrating a pericardial effusion that led to cardiac tamponade following consumption of an herbal remedy.Case Report:A 32-year-old male patient was referred to our cardiology outpatient clinic with a complaint of dyspnea. The patient’s medical history was unremarkable; however, he had consumed 3 boxes of horse chestnut (Aesculus hippocastanum L) paste over the previous 1.5 months. His chest x-ray examination revealed an enlarged cardiac shadow and bilateral pleural effusion. On transthoracic echocardiographic examination, his ejection fraction was found to be 55% with circumferentially extended pericardial effusion that reached 3.9 cm at its maximal thickness. No growth had been detected in the pericardial and pleural biopsies or blood samples; there was no evidence of an infectious process in the physical examination. Based on this information, we diagnosed pericarditis resulting from the use of herbal remedies. This is the first report to demonstrate that herbal remedy consumption may cause this type of clinical condition.Conclusions:Besides other well-known causes, pericardial effusion related to the consumption of herbal remedies should always be considered when treating patients with pericardial effusion caused by unclear etiologies.

Poisoning due to consumption of horse chestnut seed

“…The severe symptoms in our case may be due to the consumption of an entire unpurified horse chestnut seed; thus, exposing the body to a substantially high amount of antigen(s). 1,6 The exact mechanism is unclear, but we speculate that the vagus nerve and autonomic nervous system might be implicated in the atrial fibrillation. 7 Previous studies have reported no abnormalities in the levels of liver enzymes and serum/pancreatic amylase.…”

“…5 In another case, a 32-year-old man had complaints of dyspnea after consuming three boxes of horse chestnut paste over 1.5 months and was diagnosed with acute exudative pericarditis. 6 The possible mechanisms underlying the development of pericardial effusion include the strong antiaggregant effects and the production of antibodies as an immunologic response to horse chestnut antigens. 6 However, in contrast to our case, symptoms in the previous cases did not occur immediately after ingestion, and there were no reports of atrial fibrillation.…”

“…6 The possible mechanisms underlying the development of pericardial effusion include the strong antiaggregant effects and the production of antibodies as an immunologic response to horse chestnut antigens. 6 However, in contrast to our case, symptoms in the previous cases did not occur immediately after ingestion, and there were no reports of atrial fibrillation. The severe symptoms in our case may be due to the consumption of an entire unpurified horse chestnut seed; thus, exposing the body to a substantially high amount of antigen(s).…”

Management of Lower Extremity Pain from Chronic Venous Insufficiency: A Comprehensive Review

“…Eight studies reported adverse side effects in patients taking HCSE including gastrointestinal tract symptoms, dizziness, nausea, headache, and pruritus, though the reported frequencies were low (0.9–3.0%), and the frequency was not significantly different from that of placebos in three studies [ 122 ]. There was also one case report of pericardial effusion leading to tamponade as a result of the use of horse chestnut paste [ 124 ]. Three hundred milligrams of HCSE (equivalent to 50 mg of escin) taken twice daily for 12 weeks yielded therapeutic effects comparable to compression therapy with regard to edema reduction and can be recommended for patients who cannot otherwise benefit from compressive therapy [ 122 ].…”

Biological Flora of the British Isles:Aesculus hippocastanum

“…Ingestion of seeds can cause anaphylaxis (Jaspersen‐Schib, Theus, Guirguis‐Oeschger, Gossweiler, & Meier‐Abt, ; Vega et al., ) and there is a record of a 4‐year‐old boy who died after eating raw horse‐chestnuts (Lampe & Fagerstrom, ). Edem, Kahyaoğlu, and Çakar () also describe a person who developed pericarditis after consuming “3 boxes of horse‐chestnut paste” (no details given) over the previous 1.5 months. Saponins are poorly absorbed in the gut and are largely destroyed by heating, so roasting horse‐chestnuts instead of sweet chestnuts ( Castanea sativa ) is unlikely to cause great harm.…”