Am. J. Respir. Crit. Care Med.,
Volume 157, Number 2, February 1998, 594-598
Segmental Necrosis of Small Bronchi after Prolonged
Intakes of Sauropus androgynus in Taiwan
YIH-LEONG
CHANG,
YU-TUNG
YAO,
NAI-SAN
WANG,
and
YUNG-CHIE
LEE
Department of Pathology and Surgery, College of Medicine, National Taiwan University, Taipei; and National Cheng
Kung University, Tainan, Taiwan
Since 1994 an endemic of chronic obstructive pulmonary disease (COPD) has developed in Taiwan after a prevalent use of a body-weight-reducing vegetable, Sauropus androgynus (SA). All conventional
treatments for COPD, including steroids and bronchodilators, had been ineffective. Studies of limited
lung biopsy specimens from these patients revealed bronchiolitis obliterans. A few patients died, but
many developed protracted chronic respiratory failure. Because of the chronic debilitation and ineffective conventional treatments, single lung transplants were performed as the last resort in four patients. The excised lungs revealed focal fibromuscular sclerosis and obliteration of bronchial arteries
in the wall of large bronchi 4 to 5 mm in diameter with segmental necrosis of bronchi 2 to 4 mm in
diameter. Bronchi immediately proximal to the necrotic zone showed fibrosis and atrophy of cartilage, bronchial glands, and smooth muscle cells; bronchioles immediately distal showed obstruction
or dilatation. Most bronchi larger than 5 mm, pulmonary vessels, small bronchioles, and alveoli were
little altered. The pathologic changes were most consistent with segmental ischemic necrosis of
bronchi at the water-shed zone of bronchial and pulmonary circulation. The specific etiologic agent
and detail of pathogenesis of this SA-related COPD needs further investigation.
