Sheng-Xue-Xiao-Ban
Capsule (SXXBC), as a classic
Chinese traditional medicine comprised of natural
indigo, cortex moutan, forsythia, herba agrimoniae, and licorice, exhibits a heat-clearing and detoxicating function, hemostasis, and stasis dissipation, which is widely applied to treat
idiopathic thrombocytopenic purpura (
ITP). However, report on
ischemic colitis and
pulmonary embolism induced by SXXBC
therapy is never disclosed. We report the case of an
ITP patient who received SXXBC for ascending platelets that then induced
ischemic colitis and
pulmonary embolism.
Case Description: A 74-year-old female patient was admitted in June 2021 due to "
bleeding in stool for 1 day," she was then re-admitted in July 2021 due to "repeated
bleeding in stool for 2 days". Abdominal computed tomography (CT), colonoscopy, and a pathological examination suggested
ischemic colitis according to the American College of Gastroenterology (
ACG) clinical guidelines. Pulmonary artery CT angiography suggested
pulmonary embolism reflected by multiple filling defects, and the patient presented with
shortness of breath. It was noted that the patient had started taken SXXBC for ascending platelets 2 months before the onset of
hematochezia. After the diagnosis of
hematochezia was made, the patient received
phenethylamine and
carbazochrome for hemostasis,
mesalazine enteric-coated tablets for anti-
inflammation, and SXXBC was stopped. The
hematochezia then ceased, and the
ischemic colitis was attenuated. Afterwards,
low-molecular-weight heparin was administered, followed by a 3-week treatment of
rivaroxaban anticoagulant, which was taken orally after discharge. The
pulmonary embolism was then obviously ameliorated. After excluding other causes, the patient was diagnosed with SXXBC-induced
ischemic colitis complicated by
pulmonary embolism. After conducting research, we came to the view that natural
indigo, which is the main component of SXXBC, contributed to the patient's illness.
Conclusions:
Ischemic colitis complicated with
pulmonary embolism are rare; however, close attention such as regular abdominal CT test needs to be paid and preventive steps such as anti-
coagulant treatment could to be taken (if symptoms occur) when treating patients with SXXBC.