Queratouveítis y conjuntivitis causadas por Euphorbia ingens. Revisión de un caso / Keratouveitis and conjunctivitis caused by Euphorbia ingens: A case review

Euphorbia ingens es una planta ubicua, que contiene una savia lechosa. Puede accidentalmente dañar los ojos de los humanos por su naturaleza cáustica, causando conjuntivitis, queratitis, uveítis, estafiloma anterior y cicatrización corneal en pacientes no tratados. Presentamos el caso de un paciente cuyo ojo entró en contacto con esta savia lechosa, causándole conjuntivitis, defecto epitelial corneal y uveítis. Después de un tratamiento intensivo, su ojo se recuperó completamente. Recomendamos el uso de guantes y gafas protectoras antes de manipular este tipo de plantas (AU)

Euphorbia ingens is a ubiquitous plant who has a milky sap. It can accidentally harm human's eye by its caustic nature, causing conjunctivitis, keratitis, uveitis, anterior staphyloma and corneal scarring in untreated patients. We present the case of a patient whose eye came into contact with the milky sap. He suffered conjunctivitis, corneal epithelial defect and uveitis. After intensive treatment, his eye made a complete recovery. We recommend gloves and protecting glasses before handling these types of plants (AU)

Keratouveitis and conjunctivitis caused by Euphorbia ingens: A case review.

Euphorbia ingens is a ubiquitous plant who has a milky sap. It can accidentally harm human´s eye by its caustic nature, causing conjunctivitis, keratitis, uveitis, anterior staphyloma and corneal scarring in untreated patients. We present the case of a patient whose eye came into contact with the milky sap. He suffered conjunctivitis, corneal epithelial defect and uveitis. After intensive treatment, his eye made a complete recovery. We recommend gloves and protecting glasses before handling these types of plants.

Keratouveitis caused by Euphorbia milii sap: case report and overview / Ceratouveíte causada pela seiva de Euphorbia millii: relato de caso e visão geral

ABSTRACT Objective: To report a case of anterior uveitis caused by Euphorbia milii sap and review all reported cases of keratouveitis related to this species. Methods: A 64-year-old male patient presented with a 10-day history of reduced visual acuity, pain, and photophobia in the left eye after an accidental contact with Euphorbia milii sap. Best-corrected visual acuity was initially 20/200. Upon examination, ciliary injection, mild corneal edema; fine keratic precipitates, and significant anterior chamber reaction. There was no vitritis, and fundoscopy was unremarkable. The patient initiated on topical steroid and tropicamide. Results: Best-corrected visual acuity in left eye improved to 20/20 after using eyedrops for 3 weeks, associated with complete resolution of anterior uveitis. Over the following 6 months, best-corrected visual acuity remained stable, and no evidence of recurrent inflammation was observed. Conclusion: To the best of our knowledge, this is the third reported case of keratouveitis caused by Euphorbia milii sap. As observed in other cases of keratouveitis caused by sap of this species, the clinical course is benign and characterized by moderate reaction of the anterior chamber, and corneal involvement of variable intensity.

RESUMO O objetivo foi relatar um caso de uveíte anterior induzida pela seiva da Euphorbia milii e revisar todos os casos relatados de ceratouveíte causados por essa espécie. Paciente do sexo masculino, 64 anos, apresentou história de 10 dias de evolução com redução da acuidade visual, dor e fotofobia no olho esquerdo, após contato acidental com a seiva da planta Euphorbia milii. A acuidade visual com melhor correção era inicialmente 20/200. O exame revelou injeção ciliar, edema de córnea leve, precipitados ceráticos finos e reação de câmara anterior significativa. Não havia vitreíte, e a fundoscopia não exibia alterações. Foram iniciados colírios de esteroides e tropicamida. A acuidade visual no olho esquerdo melhorou para 20/20 em 3 semanas com a utilização dos colírios, além de se ter alcançado a resolução completa da uveíte anterior. Nos 6 meses seguintes, a acuidade visual permaneceu estável, e não foi observada evidência de recorrência da inflamação. Até então, este é o terceiro caso relatado de ceratouveíte pela seiva da Euphorbia milii. Como visto nos demais casos de ceratouveíte induzidos pela seiva dessa espécie, o curso clínico é benigno e caracterizado por reação moderada da câmara anterior, com envolvimento corneano de intensidade variável.

Euphorbia myrsinites Sap-Induced Phytodermatitis: A Prototype of Irritant Contact Dermatitis?

BACKGROUND: A hallmark of Euphorbia myrsinites (EM), a member of the widespread perennial Euphorbia species, is the extrusion of a poisonous, latex-like sap irritant to the skin and eye after contact. The exact mechanisms underlying these effects have not been unraveled so far. OBJECTIVES: The aims of the study were to allocate EM sap-induced phytodermatitis to irritant or allergic contact dermatitis (ACD) and to investigate mechanism(s) causing keratinocyte damage. METHODS: Cutaneous effects of EM sap on healthy human skin were investigated by clinical scoring and reflectance confocal microscopy analyses and compared with ACD. In addition, the effects of sap exposure to keratinocytes were analyzed in vitro using histological analyses and flow cytometry. CONCLUSIONS: We report on 2 cases of EM sap-induced phytodermatitis. Patch testing with fresh EM sap induced dermatitis in 100% of the tested sites with a clinical course following a decrescendo pattern. Compared with ACD, the lesional phenotype was more severe and epidermal disruption was more pronounced. Exposure of human skin tissues and cultivated keratinocytes to EM sap in vitro resulted in a dose-dependent increase in keratinocyte apoptosis. The reported findings support the primarily toxic irritant nature of EM sap-induced phytodermatitis. The contribution of ingenol mebutate to (nontoxic) proinflammatory effects remains to be elucidated.

The Scourge of the Spurge Family-An Imitator of Rhus Dermatitis.

The Euphorbiaceae family (commonly known as "spurge") is a large, diverse, and widely distributed family of plants that encompass around 300 genera and more than 8000 species. Their attractiveness and hearty nature have made them popular for both indoor ornamentation and outdoor landscaping. Despite their ubiquity, the potential to cause irritant contact dermatitis (ICD) is often overlooked in favor of more notorious causes of phytodermatitis, namely, Toxicodendron species and nettles. We examined case reports spanning 40 years and discovered that spurge-induced ICD tends to befall children and middle-aged adults who unwittingly encounter the plant through play or horticulture, respectively. Clinical presentation is pleomorphic. Erythema, edema, burning, vesicles, and pruritus of acute onset and rapid resolution are frequently observed. We present a classic case of ICD in a 12-year-old girl after exposure to Euphorbia myrsinites and review the literature on phytodermatitis caused by members of the Euphorbiaceae family.

Ultra-performance liquid chromatography-quadrupole/time-of-flight mass spectrometry analysis of the impact of processing on toxic components of Kansui Radix.

BACKGROUND: Kansui Radix (Gansui in Chinese), the dried tuber of Euphorbia kansui, is a Chinese medicinal herb commonly used for the treatment of oedema and ascites with dyspnea. Because of its toxic nature, the herb is usually processed with vinegar to reduce the toxicity. A report has shown that the contents of toxic terpenoids in Gansui decreased after processing with vinegar. However, comprehensive comparison of the chemical profiles between vinegar-processed and raw Gansui has not yet been conducted. METHODS: An ultra-high-performance liquid chromatography in conjunction with ultra-high resolution quadrupole time-of-flight mass spectrometry (UHPLC UHD Q-TOF MS/MS) method was developed for the analysis of chemical profiles of vinegar-processed and raw Gansui in this study. RESULTS: Results showed that processing with vinegar caused conspicuous chemical changes. Among the altered components, 11 toxic terpenoids, 3-O-benzoyl-13-O- dodecanoylingenol/20-O-benzoyl-13-O-dodecanoylingenol, kansuinine D, kansuinine A, 3-O-benzoyl-13-O-dodecanoylingenol/20-O-benzoyl-13-O-dodecanoylingenol, 3-O- benzoylingenol/20-O-benzoylingenol, 20-O-(2'E,4'Z-decadienoyl)ingenol/20-O-(2'E,4'E- decadienoyl)ingenol/3-O-(2'E,4'Z-decadienoyl)ingenol/3-O-(2'E,4'E-decadienoyl)ingenol, 3-O-(2'E,4'Z-decadienoyl)-20-deoxyingenol,3-O-(2'E,4'Z-,ecadienoyl)-5-O-acetylingenol,3-O-(2'E,4'Z-decadienoyl)-20-O-acetylingenol,3-O-(2,3-dimethylbutanoyl)-13-O-dodecanoylingenol, were tentatively identified. The contents of most of these terpenoids were obviously decreased after processing with reductions of 6.66-95.25%. CONCLUSION: Our findings could help us understand the chemical basis for the toxicity reduction of Gansui afforded by processing with vinegar. Further investigations are warranted to establish the relationship between processing-induced chemical changes and the reduction of toxicity of Gansui.

Phytodermatitis to Euphorbia trigona.

A 56-year-old Caucasian woman presented with acute onset of dermatitis on her face accompanied by intense itching. The patient reported that the condition began after cleaning a decorative plant, Euphorbia trigona, and contact with some drops of the plant's latex sap released upon cutting its leaves. The clinical examination revealed erythema and edema of the infraorbital and perioral regions (Figure 1). The patient was in otherwise good general health, had no personal or family history of systemic or skin disease, and was not receiving any concomitant medications. Therapy with topical methylprednisolone aceponate 0.1% cream once daily was initiated and systemic desloratadine 5 mg tablets once daily was administered for the intense itch. Seven days after the introduction of the treatment a significant improvement was noticed (Figure 2). Patch testing with the leaves of the plant as well as with the latex sap was undertaken in order to prove the causative role (Figures 3 and 4). Strongly positive reactions with bulla formation were observed on day 2 and 3, most likely suggesting acute irritation instead of true delayed hypersensitivity.

Keratouveitis caused by Euphorbia trigona sap.

We present a case of a 40-year-old female with severe keratouveitis secondary to Euphorbia trigona plant sap. The patient dropped sap into both eyes to relieve itching and developed Euphorbia keratouveitis. Visual acuity was finger counting at 1 m in both eyes on presentation. On examination, eyelid edema, ciliary injection, corneal edema with Descemet membrane folds and exudate in the anterior chamber were seen bilaterally. With supportive treatment all signs and symptoms were relieved. Exposure to Euphorbia sap should be treated immediately to prevent sequelae like corneal scarring.

Euphorbia kansui roots induced-diarrhea in mice correlates with inflammatory response.

AIM: Euphorbia kansui (E. KS) is a traditional medicine used in China for thousands of years with the effect of propulsion in the gastrointestines. However, there is no reported study of E. KS on gastrointestinal motility until now. The aim of this work is to study the effect of E. KS on the propulsion of gastrointestines, and to elucidate the possible mechanism of action. METHODS: E.KS was prepared as a 30% ethanol extract and used for the experiment of small and large intestines of mice by oral administration with three different dosages (1.2, 0.6 and 0.3 g·kg(-1)). The feces were observed in vivo. The morphology was carried out to detect if there are any changes in the intestines after the extract of E. KS administration. The assays of mRNA and protein expression were employed to observe IL-1ß, TNFα and caspase 3. RESULTS: It was shown that the extract of E.KS promoted diarrhea in mouse feces after administration, inhibited the contraction of smooth muscle of mouse small intestine and caused the inflammatory exudation on the mucosa of the intestines, enhanced the expression of both mRNA and the protein levels of IL-1ß and TNFα in the small or large intestines. CONCLUSION: The results showed that the extract of E. KS acted on the intestinal smooth muscle with propulsion of feces involving the irritation of the intestines with acute inflammatory reactions.

Bioactive components in the fruits of Ziziphus jujuba Mill. against the inflammatory irritant action of Euphorbia plants.

Chinese jujube (also known as Chinese date) is the fruit of Ziziphus jujuba Mill. (Rhamnaceae). As a famous folk medicine, it is used as antidote in traditional Chinese formula, Shi Zao Decoction, to relieve the drastic inflammatory irritant nature of Euphorbia species. The irritant activities may cause serious adverse effects in clinical practices. This study aimed to investigate the active components of Z. jujuba through the inhibitory effects on the inflammatory cells activated by Euphorbia kansui and prostratin, a phorbol ester isolated from Euphorbia fischeriana. Peritoneal macrophage of rat and splenic lymphocyte (splenocyte) of mouse were selected to evaluate these actions in vitro. Nitric oxide (NO) release of macrophage and the proliferation of splenocyte were examined through Griess method and MTT assay. TNF-α, as an important pro-inflammatory cytokines, was detected with enzyme-linked immunosorbent assay (ELISA) method. Six fractions extracted from Z. jujuba were evaluated and fraction F (triterpene acids fraction) was demonstrated to be the most active part, and then, 21 compounds isolated from Z. jujuba were tested at the concentrations range from 1 µg/ml to 100 µg/ml. The results show that 7 compounds of them are likely to be active compounds concerning to their pronounced inhibitory action on the activated inflammatory cells. These effects might be helpful to attenuate the irritant action of Euphorbiaceae plants and protect the gastrointestinal tissue from potent inflammatory injury, which should be beneficial to some diseases, like inflammatory bowel disease.

Effects of Euphorbia esula L. (leafy spurge) on cattle and sheep in vitro fermentation and gas production.

BACKGROUND: Euphorbia esula L. (leafy spurge) is indigenous to Eurasia and has been known to cause grazing aversion in ruminant species. As a result, E. esula encroachment has negatively impacted rangelands in the Northern Great Plains and Intermountain West of the USA, as well as southern Canada. Our objectives were to evaluate the effect of increasing concentrations of E. esula on in vitro dry matter digestibility (DMD) and gas production. Two ruminally-cannulated cows and ewes were used as rumen inoculum donors. To accomplish objectives, two studies were conducted. In study 1, animals were fed exclusively a barley hay (12% crude protein (CP), 55.4% neutral detergent fiber (NDF), DM basis) diet; whereas in study 2, animals were fed a diet of 15% E. esula (21.9% CP, 48% NDF, DM basis) and 85% barley hay based on previous day intake. RESULTS: The 24 and 48 h in vitro and 96 h gas production indicate that, regardless of inoculum source or substrate fermented, DMD was not influenced. Differences, however, were consistently observed across studies for NDF disappearance. CONCLUSION: Regardless of inoculum source NDF disappearance was greater when substrate being fermented contained 0%, 80%, or 100% E. esula.

Evaluation of the genotoxic and mutagenic potentials of phytotherapic and homeopathic solutions of Euphorbia tirucalli Lineu (Aveloz) / Evaluation of the genotoxic and mutagenic potentials of phytotherapic and homeopathic solutions of Euphorbia tirucalli Lineu (Aveloz)

Introduction: Euphorbia tirucalli Lineu, commonly known as Aveloz, is a very common plant found in tropical regions [1]. The ingestion or contact with its latex causes symptoms such as vomiting and diarrhea, pallor, skin irritation, hepatotoxicity as well as carcinogenesis [2]. Moreover, the Aveloz latex is also responsible for a few important activities against some infectious and neoplastic diseases. Aveloz latex phytochemical composition may vary according to seasonal aspects and geographic location [3], and it is used either orally or topically in traditional medicine. Popularly known as an antitumoral agent (breast, prostate, lung, kidney), it is used not only in Brazil, but in several other countries. According to the literature, the latex could have a dual behaviour, activating or inhibiting tumoral events [3-6]. However, there are few reports discussing these mechanisms. Besides, the mutagenic and genotoxic potentials of phytochemical and homeopathic Aveloz have not yet been described. Several experimental methods have been used to evaluate the mutagenic and genotoxic effects, such as Inductest, the Ames test and the chromotest. Objective: This study aims to evaluate the genotoxic and mutagenic potentials of Aveloz latex and Aveloz phytotherapic and homeopathic solutions. Methodology: In this study, Aveloz 5 and 30cH are prepared according to Brazilian Homeopathic Pharmacopoeia [7], from Aveloz latex collected in the Center for Natural Products Research (NPPN) at the Universidade Federal do Rio de Janeiro [8]. The Aveloz phytochemical solution was prepared following the doses used in folk medicine: 2 drops diluted in 250ml of water and 2 drops diluted in 25 ml of water. All test solutions were submitted to the following methodologies: (a) Inductest: assesses the ability of physical or chemical agents to promote lysogenic induction as a response to DNA damage in lysogenic bacteria; (b) The Ames test: uses indicator strains of Salmonella typhimurium, which are sensitive to substances that can induce different types of mutation; (c) Chromotest: evaluates the genotoxicity of chemicals through the induction of the bacterial SOS system. Results: In the Inductest there was no decrease in bacterial survival fraction and no increase in lysogenic cycle. As measured by The Ames test and the chromotest no mutagenic or genotoxic potentials were detected. Discussion: The homeopathic and the phytochemical Aveloz solutions were unable to produce lysogenic induction or mutagenesis in bacterial cells and they were also unable to produce genotoxic effects, as measured by chromotest. Conclusion: Our results showed that no mutagenic or genotoxic damages were induced by all Aveloz preparations studied, thus we are led to believe that patients using Aveloz as a complementary therapy present no side effects in relation to mutagenesis and genotoxicity.

Beware the ornamental plant.

A keen female gardener presented to the emergency department of the hospital with a large corneal abrasion, conjunctival injection, an anterior chamber reaction and a hypopyon. She put it down to trauma that day while gardening, as she had been pruning her patio plant. The Euphorbia species of ornamental plants have been known to cause an intense reactive anterior uveitis and kerato-conjunctivitis caused by the milky sap it produces. Emergency medicine doctors and ophthalmologists should be aware of the effects of the sap of the Euphorbia species of plants.