Abstract
BackgroundHemolysis can occur in people with G6PD deficiency under oxidative stress. Acalypha indica is a tropical plant used as a medicinal plant as well as a vegetable. There are a few reported cases of Acalypha indica ingestion induced hemolysis in G6PD deficient people. All except one of them are from Sri Lanka. The information available at present (2017) about G6PD deficiency prevalence and variants of the G6PD gene among Sri Lankans is very sparse. There are no past reports on hemolytic crisis in a G6PD deficient person presenting mimicking leptospirosis.Case presentationA middle-aged Sri Lankan man presented on the third day of illness complaining of fever, head ache, arthralgia, myalgia, abdominal pain, vomiting, passing dark urine and reduced of urine volume. He gave a history of possible exposure to leptospirosis. He was pale, icteric and his liver was palpable 1 cm below costal margin and there were no other remarkable findings upon physical examination. He had neutrophilic leucocytosis. Leptospirosis was diagnosed. During the second assessment we noticed he was very pale and his urine sample pointed towards hemoglobinuria. Further questioning revealed he had consumed leaves of Acalypha indica as a vegetable. Acute hemolysis in a G6PD deficient patient following Acalypha indica ingestion was diagnosed. Blood transfusions were given to correct his anemia. Later, Brewer’s test and quantitative assay of G6PD levels confirmed the diagnosis of G6PD deficiency.ConclusionsA hemolytic crisis following oxidative stresses in G6PD deficient patients can present mimicking leptospirosis. Further investigations may reveal why the great majority of cases of acute hemolysis in G6PD deficient person following Acalypha indica ingestion are from Sri Lanka.
Highlights
Hemolysis can occur in people with Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency under oxidative stress
Further investigations may reveal why the great majority of cases of acute hemolysis in G6PD deficient person following Acalypha indica ingestion are from Sri Lanka
That may be mere coincidence or may be because some G6PD deficiency genotypes and G6PD enzyme phenotypes common among Sri Lankans are more susceptible to Acalypha indica induced hemolysis
Summary
Hemolytic crisis following oxidative stresses in G6PD deficient patients can present mimicking leptospirosis. Consumption of Acalypha indica leaves as a vegetable can results in severe hemolytic anemia in some G6PD deficient patients. Screening and awareness campaigns regarding G6PD deficiency in high prevalence areas can reduce the probability of such patients getting a life-threatening hemolytic crisis as in this case. Further studies may reveal whether certain G6PD deficiency genotypes and G6PD enzyme phenotypes common among Sri Lankans are more susceptible to Acalypha indica induced hemolysis. Authors’ contributions NDBE, ANA and TNS contributed to management of this patient. NDBE did the literature survey and wrote the manuscript. ANA and TNS approved the manuscript after perusal. NDBE, ANA and TNS approved final the version to be published and agreed to be accountable for all aspects of the work. All authors read and approved the final manuscript
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