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Case report of vasculitic rash induced by Ginkgo biloba and/or Horny Goat Weed

Metz, Dominik

; Weston, Philip

; Barker, Diane

.  BMJ Case Reports

; London Vol. 2009,  (2009). DOI:10.1136/bcr.07.2008.0399

BACKGROUND

This is the first time that such an adverse drug reaction to either Ginkgo biloba or Horny Goat Weed has been reported. We consider it important to highlight such adverse reactions when they do materialise, given the increasing popularity and usage of complementary medicines. It is important that the medical community keeps pace by detecting and publishing potentially serious side effects so that a true risk profile can be established for each of the remedies and further action is taken if deemed necessary.

CASE PRESENTATION

A 77-year-old gentleman was referred by his general practitioner to the medical admissions unit in the Royal Liverpool University Hospital with a 2 day history of a painful rash. The rash was vasculitic in appearance: erythematous maculopapular eruptions were first noticed on his lower legs ( figs 1 and 2 ). Over the next 2 days he developed more of these eruptions on his legs and a few smaller ones on his arms.

The largest patch of purplish discolouration on his right lateral leg ( fig 3 ) was associated with a burning sensation. He was otherwise asymptomatic and remained apyrexial throughout his 3 day admission.

Four days prior to seeking medical advise he had started taking Ginkgo biloba and Horny Goat Weed (active ingredient: Epimedium ), which he had purchased from a health food retailer (Holland and Barrett, Nuneaton, UK). The full list of ingredients for each remedy is given in table 1 . 1