Hypericum abuse
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Epistaxis (first report) following intranasal administration: case report A 30-year-old man experienced prolonged epistaxis after misusing hypericum [St John’s wort; dose and indication unknown]. Soon after ’snorting’ 1 tablet of hypericum up his left nostril [exact time to onset not stated], he experienced a burning sensation in his left nostril, followed by unilateral bleeding. By the time he presented to hospital, the bleeding had been intermittent for 12 hours. The man was hospitalised and had 10cm nasal tampons packed into his nostrils, which failed to control the bleeding. Anterior rhinoscopy showed the left nasal septum to be the source, although the exact site of bleeding was difficult to determine. He became haemodynamically unstable (haemoglobin 100 g/L), and was taken to the operating theatre where he underwent surgery. Endoscopy under general anaesthesia showed severe bleeding from the roof of the left nasal cavity, the spheno-ethmoidal recess and the medial surface of the left middle turbinate. Bleeding continued from multiple points, despite the application of epinephrine [adrenaline]-soaked neurosurgical patties and local bipolar diathermy. He therefore underwent endoscopic sphenopalatine artery ligation. As this only partially controlled the bleeding, an anterior ethmoidal artery ligation was then carried out. Performed externally via a medial canthal incision, this was successful in achieving haemostasis. He recovered well and was discharged from hospital the next day. There were no sequelae on otolaryngological follow-up. Author comment: "It is not clear which of the components of St. John’s wort was responsible for our patient’s epistaxis. However, it seems probable that at least one ingredient must be capable of producing such severe and clearly localised bleeding in a young man with no significant comorbidity or history of trauma." Crampsey DP, et al. Nasal insertion of St John’s wort: an unusual cause of epistaxis. Journal of Laryngology and Otology 121: 279-280, No. 3, Mar 2007 801096024 Scotland
» Editorial comment: A search of AdisBase and Medline did not reveal any previous case reports of epistaxis associated with hypericum. The WHO Adverse Drug Reactions database contained two reports of epistaxis associated with Hypericum perforatum.
0114-9954/10/1183-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 5 Jan 2008 No. 1183
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