Acalypha indica-induced transient glucose-6-phosphate dehydrogenase deficiency with acute haemolysis

Abstract

Acalypha indica is a tropical herb found in Asia. The entire plant, especially the leaves, is used in herbal medicine for several therapeutic purposes. Acute intravascular haemolysis and methaemoglobinaemia have been reported in patients who consume this herb. We present a case of a previously healthy middle-aged man who ingested boiled leaves of A. indica. The patient developed clinical symptoms and signs of intravascular haemolysis 7 days after ingestion. Peripheral blood smear showed typical findings of glucose-6-phosphate dehydrogenase (G6PD) deficiency with acute haemolysis. The G6PD activity was low during active haemolysis. The G6PD level, however, returned to normal after 4 months of follow-up. The patient was further tested for common G6PD gene mutations in Southeast Asia and was negative. Ingestion of A. indica may induce transient G6PD deficiency, which in this patient led to acute haemolysis and methaemoglobinaemia.

Acalypha indica induced acute oxidative haemolysis and methaemoglobinaemia: two case reports

“…Acute hemolysis with A. indica resulting in the subsequent discovery of G6PD deficiency was reported previously from South India, Sri Lanka, Malaysia, and Thailand, with most cases from Sri Lanka [ 2 , 3 , 7 – 12 ]. The majority of the reported patients were men.…”

“…Although the specific compound responsible for methaemoglobin formation was not identified in this case, it is important to consider the potential for such herbal remedies to induce methaemoglobinaemia. The occurrence of coexistent methaemoglobinaemia and haemolysis with A.indica is uncommonly reported [ 2 , 10 – 12 ]. Almost all reported cases of A.indica -induced methaemoglobinaemia were mild with a maximum level reported of 23.9% [ 2 ].…”