Case Report

Hemorrhagic Cystitis Induced by an Herbal Mixture

Authors: Maria Antonietta Catania, MD, Alessandro Oteri, PharmD, Paola Caiello, MD, Alessandra Russo, MD, Francesco Salvo, MD, Ettore Saffi Giustini, MD, Achille Patrizio Caputi, MD, Giovanni Polimeni, PharmD


A healthy 33-year-old woman consumed a slimming product containing a mixture of herbal remedies without seeking medical advice. Two months later, the patient had hemorrhagic cystitis and discontinued the herbal product. Symptoms spontaneously remitted in a few days. Four months later, she took the same herbal remedy and the hemorrhagic cystitis reappeared. She then consulted her general practitioner. A urine culture test was negative, and the patient was advised to discontinue the herb intake. Again, the cystitis resolved within a week. The product involved contains a mixture of herbs, some of which have been associated with adverse effects that might account for the symptoms reported in this case.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Thomas KJ, Nicholl JP, Coleman P. Use and expenditure on complementary medicine in England: a population based survey. Complement Ther Med 2001;9:2–11.
2. Goldstein LH, Elias M, Ron-Avraham G, et al. Consumption of herbal remedies and dietary supplements amongst patients hospitalized in medical wards. Br J Clin Pharmacol 2007;64:373–380.
3. Lynch N, Berry D. Differences in perceived risks and benefits of herbal, over-the-counter conventional, and prescribed conventional, medicines, and the implications of this for the safe and effective use of herbal products. Complement Ther Med 2007;15:84–91.
4. De Smet PAGM. An introduction to Herbal Pharmacovigilance, in De Smet PAGM, Keller K, Hansel R (eds): Adverse Effects of Herbal Drugs. Heidelberg, Springer-Verlag, 1997, vol 3, pp 1–13.
5. Herrera S, Bruguera M. [Hepatotoxicity induced by herbs and medicines used to induce weight loss.] Gastroenterol Hepatol 2008;31:447–453 [in Spanish].
6. Man SC, Durairajan SS, Kum WF, et al. Systematic review on the efficacy and safety of herbal medicines for Alzheimer's disease. J Alzheimers Dis 2008;14:209–223.
7. Skalli S, Zaid A, Soulaymani R. Drug interactions with herbal medicines. Ther Drug Monit 2007;29:679–686.
8. Ernst E. Herbal medicines: balancing benefits and risks. Novartis Found Symp 2007;282:154–167; discussion 167–72, 212–218.
9. Traxer O, Desgrandchamps F, Sebe P, et al. [Hemorrhagic cystitis: etiology and treatment.] Prog Urol 2001;11:591–601 [in French].
10. deVries CR, Freiha FS. Hemorrhagic cystitis: a review. J Urol 1990;143:1–9.
11. Walker RD. Cyclophosphamide induced hemorrhagic cystitis. J Urol 1999;161:1747.
12. Bramble FJ, Morley R. Drug-induced cystitis: the need for vigilance. Brit J Urol 1997;79:3–7.
13. Martinez-Suarez HJ, Wang R, Faerber GJ. Atorvastatin-induced hemorrhagic cystitis: a case report. Urology 2009;73:681.e5–e6.
14. Conz PA, La Greca G, Benedetti P, et al. Fucus vesiculosus: a nephrotoxic alga? Nephrol Dial Transplant 1998;13:526–527.
15. Maurer HR. Bromelain: biochemistry, pharmacology and medical use. Cell Mol Life Sci 2001;58:1234–1245.
16. Heinicke RM, van der Wal L, Yokoyama M. Effect of bromelain (ananase) on human platelet aggregation. Experientia 1972;28:844–845.
17. Ako H, Cheung AH, Matsuura PK. Isolation of a fibrinolysis enzyme activator from commercial bromelain. Arch Int Pharmacodyn Ther 1981;254:157–167.
18. Schütz K, Carle R, Schieber A. Taraxacum—a review on its phytochemical and pharmacological profile. J Ethnopharmacol 2006;107:313–323.
19. Williams CA, Goldstone F, Greenham J. Flavonoids, cinnamic acids and coumarins from the different tissues and medicinal preparations of Taraxacum officinale. Phytochemistry 1996;42:121–127.
20. Mabey R. The Complete New Herbal. London, Elm Tree Books, 1988.
21. Duke JA. Handbook of Medicinal Herbs. Boca Ranton, CRC, 1985.
22. Naranjo CA, Busto M, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30: 239–245.