Lead Intoxication Caused by Traditional Chinese Herbal Medicine
Article Outline
To the Editor:
The total number of people using traditional Chinese herbal medicine is vast and steadily increasing in East Asian countries and Chinese society. The industrial output value of traditional Chinese herbal medicine has also continued to expand rapidly across the world since the year 2000.1 Here we describe a case of lead intoxication following the use of traditional Chinese herbal medicine as an agent for maintaining health.
A 25-year-old man, a teaching assistant at a university, with no significant medical history, presented with progressive exertional dyspnea for 2 months. An intermittent pulling-like pain over his anterior subcostal region had developed 2 weeks before his admission. He reported neither bloody vomiting nor tarry or bloody stools. His physical examination was normal except for pale conjunctiva. His renal and liver function, electrolytes, gastroscopy, colonoscopy, and computed tomography were all unremarkable. Serial investigations showed hypochromic microcytic anemia (hemoglobin 8.3 g/dL). The red blood cell morphology showed anisocytosis with basophilic stippling (Figure).
Figure.
The blood smear showed basophilic stippling (arrow).
A review of his medical history found that for the past 3 months he had been taking a traditional Chinese herbal medicine known as Qushangjieyu-san powder. The diagnosis of lead intoxication was confirmed by his blood lead level (75.5 μg/dL, normal <35 μg/dL), as well as the lead content (80,309.95 μg/g, normal <5 ppm) of the Qushangjieyu-san powder. He discontinued the herbal medicine and was started on chelation therapy through the intravenous administration of calcium disodium ethylenediaminetetraacetate (CaNa2EDTA). His abdominal pain, blood lead concentration, and microcytic anemia resolved following the 3-week course of chelation treatment.
Discussion
Traditional Chinese medicine is an important part of Chinese medical science and culture. About 9000 kinds of traditional Chinese herbal preparations are sold on the market.1 In Chinese society, patients tend to consult doctors of both Chinese medicine and Western medicine,2 and commonly use traditional Chinese herbal medicine to treat disease and maintain health.3 In Hong Kong and China, about 20% of the households choose Chinese medicine doctors and herbal medicines.4 Moreover, the use of alternative healing options, including traditional Chinese herbal medicine, is increasing in Western societies as well.5
Similar to other drugs, traditional Chinese herbal medicine can cause side effects. Manufacturing and quality problems can result in the adulteration or contamination of traditional Chinese herbal medicine, which could cause adverse drug reactions.6 Traditional Chinese herbal medicine therapy is reported to be a risk factor for high blood lead concentration.7 Diagnosis and treatment of lead intoxication include identifying and discontinuing the environmental exposure and administering chelation therapy. However, the boundaries between food and herbal medicines are quite permeable in Chinese society. Therefore, taking a careful history, paying special attention to diet and medications, is very important.
From this case, we learned that traditional Chinese herbal medicine can produce lead intoxication resulting in microcytic anemia and abdominal pain, and that physicians need to take patient histories carefully, being aware of the possible side effects of herbal medicines. A quick heavy-metals analysis can ensure an accurate diagnosis and avoid unnecessary investigations.
References
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- Pharmacovigilance in Traditional Chinese Medicine safety surveillance . Pharmacoepidemiol Drug Saf . 2009;18:357–361
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Funding: None.
Conflict of Interest: None.
Authorship: All listed authors had access to the data used in the paper. Lin WH and Cheng HC contributed to the writing of the manuscript.
PII: S0002-9343(11)00635-8
doi:10.1016/j.amjmed.2011.06.030
© 2012 Elsevier Inc. All rights reserved.
