Outbreak of obstructive ventilatory impairment associated with consumption of Sauropus androgynus vegetable

Background: Forty four individuals, suffering from temporary insomnia and poor appetite followed by progressive difficulty breathing after four weeks or more ingestion of the Sauropus androgynus or Sabah vegetable, were reported to the National Poison Center of Taiwan by physicians between August 23, 1994 and August 25, 1995. Objective: A telephone questionnaire survey was designed and conducted to collect demographic data, information about use of the vegetable, past medical history and clinical presentation. Laboratory data were obtained from their physicians as available. Results: Forty one patients, predominantly women, 43 +/- 11 years old, were identified in our survey. They reported a variety of sources and preparation methods for the vegetable. Difficulty breathing, identified in 36 cases, was the clinical hallmark. Twenty people gave a history of dyspnea delayed until 44 +/- 40 days after discontinuing vegetable consumption. Laboratory evidence of obstructive ventilatory impairment (FEV(1)/FVC 56 +/- 12%, FEV(1) 31 +/- 6%, PaO2 71 +/- 15%) was observed in 12 cases tested. An open lung biopsy performed in a demonstration case disclosed bronchiolitis obliterans organizing pneumonia. Conclusion: In this case series of 41 victims, we have identified a severe pulmonary effect and hypothesize that it is related to consumption of sauropus androgynus vegetable. Papaverine has been previously identified in this vegetable but is unlikely to be responsible for the full range of toxicity seen.