Lung transplantation for patients with end-stage Sauropus androgynus-induced bronchiolitis obliterans (SABO) syndrome

Sauropus androgynus (SA), a vegetable of the Euphorbiaceae family, is a com mon food source in Malaysia. In Taiwan, over 30 patients have developed pro gressive respiratory failure after consuming the extract from raw SA leaves as a means of losing weight. Symptoms consistent with a severe obstructive ventilatory defect progressed, despite cessation of SA intake and treatmen t with bronchodilators, corticosteroids, cytotoxic agents and plasmaphresis . Five patients with end-stage Sauropus androgynus-induced bronchiolitis ob literans (SABO) syndrome underwent lung transplantation. There was no early mortality. One patient died of post-transplant lymphoproliferative disorde r and another patient died of bronchial stenosis with infection, 5 and 3.5 months, respectively, post-transplantation. The remaining 3 patients have b een followed from 29 to 34 months, with improved general condition and pulm onary function. Perfusion/ventilation scans revealed that these improvement s were exclusively attributed to the functional grafts. We believe that lun g transplantation is the only effective modality of treatment for patients with end-stage SABO syndrome.