Gülay NURLU, Rana KARABUDAK, Aslı Tuncer KURNE, Bahar KAYMAKAMZADE

Acute Disseminated Encephalomyelitis after Oral Therapy with Herbal Extracts: A Case Report

Background: Acute disseminated encephalomyelitis(ADEM) is a rare demyelinating disease of the centralnervous system, commonly attributed to infectionsor vaccinations. Toxic or allergenic compounds canalso trigger a response in the immune system and maycause demyelination. We present a case with ADEMafter using oral herbal medications.Case Report: A 25 year-old male developed bilateralcentral facial palsy and severe quadriparesis aftertaking herbal drugs (containing echinacea and manyother herbal ingredients) for two weeks. He had usedthe extract to increase his potency and reproductivity.He had no past history of recent immunization or viralinfection. The clinical findings, cerebrospinal fluid(CSF) analysis and brain magnetic resonance imaging(MRI) were compatible with ADEM. The neurologicalfindings were improved after seven doses of pulsemethylprednisolone treatment. To our knowledge,this is the third report in the literature that links herbaltherapy and demyelinating disease.Conclusion: Most of the ADEM cases related to herbaltherapy in the literature similarly used echinacea. Itis our opinion that other ingredients of the herbal extractused by our case, besides echinacea, could havethe potential to cause a trigger in the immune system.Further studies are needed to clarify the immunologicaleffects of different kinds of herbal compounds, aswell as the effects of different parts of the plants andthe results of various dosages. Moreover, ingredientsshould also be tested for toxicity, adverse effects anddrug interactions.

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1. Rudick RA, Eskin TA. Enhanced vascular permeability in acute disseminated vasculomyelinopathy. Ann Neurol 1981;9:621. [CrossRef]
2. Schwarz S, Knauth M, Schwab S, Walter-Sack I, Bonmann E, Storch-Hagenlocher B. Acute disseminated encephalomyelitis after parenteral therapy with herbal extracts: a report of two cases. J Neurol Neurosurg Psychiatry 2000;69:516-8. [CrossRef]
3. Kostianovsky A, Maskin P, Noriega MM, Soler C, Bonelli I, Riley CS, et al. Acute demyelinating disease after oral therapy with herbal extracts. Case Rep Neurol 2011;3:141-6. [CrossRef]
4. Singh D, Gupta R, Saraf SA. Herbs-are they safe enough? an overview. Crit Rev Food Sci Nutr 2012;52:876-98. [CrossRef]
5. Mullins RJ, Heddle R. Adverse reactions associated with echinacea: the Australian experience. Ann Allergy Asthma Immunol 2002;88:42-51. [CrossRef]
6. Kocaman O, Hulagu S, Senturk O. Echinacea-induced severe acute hepatitis with features of cho-lestatic autoimmune hepatitis. Eur J Intern Med 2008;19:148. [CrossRef]
7. Burger RA, Torres AR, Warren R, Caldwell VD, Hughes BG. Echinacea-induced cytokine production by human macrophages. Int J Immunopharmacol 1997;19:371-9. [CrossRef]
8. Yamada K, Hung P, Park TK, Park PJ, Lim BO. A comparison of the immunostimulatory effects of the medicinal herbs Echinacea, Ashwagandha and Brahmi. J Ethnopharmacol 2011;137:231-5. [CrossRef]
9. Gertsch J, Schoop R, Kuenzle U, Suter A. Echinacea alkylamides modulate TNF-alpha gene expression via cannabinoid receptor CB2 and multiple signal transduction pathways. FEBS Lett 2004;577:563-9. [CrossRef]
10. Raduner S, Majewska A, Chen JZ, Xie XQ, Hamon J, Faller B, et al. Alkylamides from Echinacea are a new class of cannabinomimetics. Cannabinoid type 2 receptor-dependent and -independent immunomodulatory effects. J Biol Chem 2006;281:14192- 206. [CrossRef]
11. Uluışık D, Keskin E. Effects of ginseng and echinacea on cytokine mRNA expression in rats. ScientificWorldJournal 2012;2012:942025. [CrossRef]
12. Giavina-Bianchi PF Jr, Castro FF, Machado ML, Duarte AJ. Occupational respiratory allergic disease induced by Passiflora alata and Rhamnus purshiana. Ann Allergy Asthma Immunol 1997;79:449-54. [CrossRef]
13. Otang WM, Grierson DS, Afolayan AJ. A survey of plants responsible for causing irritant contact dermatitis in the Amathole district, eastern cape, south Africa. J Ethnopharmacol 2014;157:274-84. [CrossRef]