The Poison Review

HEMORRHAGIC CYSTITIS INDUCED BY AN HERBAL MIXTURE Catania MA et al. Southern Med J Jan 2010;103:90-92.

Abstract

This case report from Italy describes a 33-year-old woman who developed two episodes of hemorrhagic cystitis (dysuria and microscopic hematuria) after 4 – 8 weeks of consuming an herbal diet preparation called Slim-Kombu®. Both episodes resolved after she stopped taking the preparation.  The authors hypothesize that several ingredients in the mixture — including bladderwrack (fucus vesiculosus), pineapple (Ananas comosus), and juniper — may have caused the clinical presentation.

Unfortunately, their case seems less than fully convincing, despite their claim that the Naranjo adverse drug reaction probability scale shows a probable association.  Although I had to read the paper twice to notice this, during the first episode of “hemorrhagic cystitis” the patient never sought medical care; she simply discontinued the herbal mix voluntarily and found that the symptoms resolved.  Given this fact, it’s hard to see how the authors can claim that her urine during that episode was sterile or that she had microscopic hematuria.  She very well might have had a self-limited UTI.  Also, there’s no clear previously reported association between any of the ingredients in the herbal mixture and hemorrhagic cystitis. The most frequent cause of drug-induced hemorrhagic cystitis is cyclophosphamide.