Bronchiolitis Obliterans Organizing Pneumonia Following Consumption of Sauropus androgynus

Bronchiolitis obliterans organizing pneumonia (BOOP) is a rare disorder affecting the small airways, alveoli and the walls of small bronchi. This form of lung injury involves inflammation and stiffening of lung areas with organized tissue. There are several known causes of BOOP, and several systemic disorders have BOOP as an associated primary pulmonary lesion. An outbreak of BOOP among young women has been publicly reported in Taiwan from late 1994 and onward. The source of the illness was traced to the consumption of Sauropus androgynus. Herein, we describe a case of a 28-year-old woman who developed a rapid pulmonary toxicity after drinking fresh S. androgynus purée daily for a period of two months, as an alleged regimen for weight reduction. Ga-67 citrate imaging portrayed the inflammatory status in her eyes, parotids and lungs. Pathological pattern of open-lung biopsy specimens was characteristic of BOOP. The toxicity is believed related to alkaloid papaverine contained in the plant. Bioactive principles of S. androgynus and pathogenetic mechanism underlying BOOP remain unidentified.