A case of ischemic colitis associated with the herbal food supplement ma huang

Abstract

Ischemic colitis is a condition that usually occurs in the elderly, as a form of vascular disease. However, ischemic colitis also occurs, though rarely, in healthy young adults. Moreover, food supplements containing Ephedra sinica or ma huang have been linked to adverse central nervous and cardiovascular events. A 40-year-old man was admitted to our emergency department after 2 episodes of abdominal pain and bloody diarrhea that lasted 24 hours. His medical history was unremarkable for risk factors of bowel ischemia, except for well-controlled hypertension. However, a weight-loss supplement, Ephedra sinica, had been prescribed for daily use during the previous month. Both abdominal/pelvic computed tomography and colonoscopy revealed findings compatible with ischemic colitis. His conditions spontaneously improved without any serious complications, and he was advised to discontinue the use of herbal medications containing ephedrine. In this paper, we describe a case of ischemic colitis that was potentially linked to the use of ma huang with a review of the relevant literature.

Fig. 1

Abdominal and pelvic CT scans show a patent superior mesenteric artery (A) and edematous circumferential wall thickening of the ascending, transverse, and descending colon (B).

Fig. 2

(A) Colonoscopy on admission show hemorrhagic friable mucosal patches with mucosal edema from the ascending to the descending colon. (B) Colonoscopy at an 8-day follow-up show marked mucosal improvement.

Fig. 3

Colonoscopic biopsy specimen from the transverse colon show focal mucosal erosion and chronic inflammatory cell infiltration (H&E stain, × 200).