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We report a 67-yr-old woman with hepatitis C related liver cirrhosis and hepatoma who had developed severe bone marrow suppression after taking Cantharanthus roseus as an alternative anticancer treatment. The patient developed severe pancytopenia with initial presentations of vomiting, diarrhea, oral ulcer, and fever about 1 week after taking 5-days' course of Cantharanthus roseus. Bone marrow biopsy showed autolysis, which indicated massive necrosis of the hematopoietic cells. There was no malignant cell infiltration. The patient also bad severe gastrointestinal disturbances, bacteremia, urinary tract infection, and impaired renal and liver function. Supportive care with broad-spectrum antibiotics, granulocyte colony-stimulating factor, repeated blood transfusions, and albumin supplement was given. She recovered and was discharged after 48 days hospitalization. Coadministration of Cantharanthus roseus and cisapride was noted, and these two drugs are both substrates of cytochrome P450 3A4 enzymes (CYP 3A4). Because the vinca alkaloids are extensively metabolized by the liver cytochrome P450 enzymes, poor hepatic function and drug-herb interaction might predispose the patient to develop the bone marrow toxicity. This case report demonstrated possible effect of oral dose of vinca alkaloids and also hinted that all the substrates and inhibitors of CYP 3A4 have propensity to interfere with metabolism of vinca alkaloids. Key Words: Cantharanthus roseus; Vinca alkaloids; Herbal poisoning; Bone marrow suppression; Drug interaction., INTRODUCTION Cantharanthus roseus, a common potted plant, a species of myrtle, belongs to the family Apocynaceae (1,2). It is a herbaceous subshrub, 40-80 cm high, becoming woody at the base. [...]

In graft-versus-host disease, immune cells within grafted tissue attack the body components of their new host. While the condition is of great concern in bone marrow transplantation, the immune cells contained within transfused blood are rarely a problem unless the transfusion recipient is immunocompromised. However, this is precisely the case with many patients with malignant lymphoma. The success rate in the treatment of lymphoma has greatly improved in recent years, but the strength of the chemotherapeutic drugs used also exposed the patient to a period of immunosuppression during which infections pose a great threat. The case is present of a patient receiving transfused blood who died of complications resulting from graft-versus-host disease. The patient, a 31-year-old woman, had nodular sclerosing Hodgkin's disease. Over a period of almost a year, she was given eight full cycles of chemotherapy. During the ninth cycle, she developed fever and experienced a reduction in red and white blood cells as well as platelets; a transfusion was indicated. The woman received a total of 14 units of platelets and three units of red blood cells. The transfused materials were not irradiated. Seven days after the first infusion of platelets the patient developed a rapidly progressive rash; skin biopsy revealed signs of graft-versus-host disease. The patient had persistent signs of bone marrow aplasia (the bone marrow was failing to produce an adequate supply of fresh blood cells). A bone marrow transplantation was performed, but the patient died of complications involving the heart, systemic infection with Candida krusei, and lung infarction due to infection with Aspergillus and Pneumocystis carinii. A review of the medical literature revealed 20 reports of lymphoma patients who developed graft-versus-host disease after transfusion; only one of these patients survived. While the irradiation of blood adds additional cost to a transfusion, irradiated blood does not cause graft-versus-host disease, and the added expense may be life-saving for immunosuppressed patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

A case of subclinical valproic acid dose-related pancytopenia is reported. The patient is a 65-year-old man who was prescribed valproic acid for bipolar mood disorder.

Infection with the bacteria-like organism Chlamydia psittaci, is most often transmitted by bird droppings, and is characterized by fever, respiratory illness, an increase in the levels of antibody, or immune protein, directed against C. psittaci, and rarely, blood disorders. A case is described of a 55-year-old woman with C. psittaci infection complicated by severe pancytopenia, or a decrease in the numbers of all blood cells. She was admitted to the hospital with fever, headache, general discomfort, cough with a whitish sputum, a purplish discoloration over the extremities, and deteriorating mental function. The patient reported having a pet bird at home for about one year. Blood tests revealed pancytopenia, and examination of bone marrow specimens showed an increase in histiocytes, which are cells with the ability to phagocytose, or ingest and break down, particles. These histiocytes were capable of phagocytosing red blood cells, white blood cells, and platelets (cells involved in blood clotting). In this patient, the histiocytes accounted for five percent of all bone marrow cells with a nucleus. The patient was diagnosed with reactive hemophagocytic syndrome, a condition characterized by the overgrowth of unusual histiocytes that phagocytose blood cells, fever, enlargement of the spleen and liver, and pancytopenia. She was treated with the antibiotics erythromycin, carbenicillin, and amikacin, and her fever resolved within 48 hours. The numbers of blood cells recovered to normal values within two weeks. Reactive hemophagocytic syndrome is most often associated with viral infection and lymphoma, a cancer of the lymphatic system. This is the first reported case of reactive hemophagocytic syndrome associated with C. psittaci infection. Patients with reactive hemophagocytic syndrome should be assessed for infection with C. psittaci. (Consumer Summary produced by Reliance Medical Information, Inc.)