title: Bone marrow necrosis: a rare complication of herbal treatment with Hypericum perforatum (St. John's wort).
abstract: A 22-year-old man presented with fever and ulceration of the oral mucosa. The patient had pharyngeal and esophageal candidiasis. For the 3 weeks prior to presentation, he had been taking approximately 1000 mg/day of flowering herbs (Hypericum perforatum L, known as St. John's wort) for treatment of depression. A complete blood count on the first day of hospitalization showed agranulocytosis and normocytic anemia. His condition worsened, and he developed progressive dysphagia. A bone marrow biopsy on day 3 revealed bone marrow necrosis. After the diagnosis was established (day 3 of hospitalization), treatment with granulocyte colony-stimulating factor 48 U/day, intravenous immunoglobulin 400 mg/kg, and amphotericin B 100 mg/day was initiated. The patient did not respond, and died within one week of the diagnosis. This cases suggests that Hypericum species may lead to severe hematologic toxicity, with conditions involving bone marrow necrosis.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, University of Baskent, School of Medicine, Adana Teaching and Medical Research Center, Adana, Turkey.
authors.forename: Yusuf Zja
authors.initials: YZ
authors.lastname: Demiroglu
authors.forename: Tuba Turunc
authors.initials: TT
authors.lastname: Yeter
authors.forename: Can
authors.initials: C
authors.lastname: Boga
authors.forename: Hakan
authors.initials: H
authors.lastname: Ozdogu
authors.forename: Ebru
authors.initials: E
authors.lastname: Kizilkilic
authors.forename: Nebil
authors.initials: N
authors.lastname: Bal
authors.forename: Ilhan
authors.initials: I
authors.lastname: Tuncer
authors.forename: Hande
authors.initials: H
authors.lastname: Arslan
mesh_terms: D000328:Adult; D001853:Bone Marrow / Q000187:drug effects* / Q000473:pathology; D003863:Depression / Q000188:drug therapy; D006801:Humans; D020902:Hypericum / Q000009:adverse effects*; D008297:Male; D009336:Necrosis; D008517:Phytotherapy / Q000009:adverse effects*; D010936:Plant Extracts / Q000009:adverse effects*
chemical_list: D010936:Plant Extracts