Zha Mengyi, Ding Delaney D
Yakima Valley Farm Workers Clinic, Yakima, WA, USA.
University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610, USA.
J Med Case Rep. 2025 May 30;19(1):259. doi: 10.1186/s13256-025-05167-5.
Unregulated herbal supplements can pose significant health risks due to undisclosed ingredients. Tawon Liar, an Indonesian product marketed as an "all-natural" remedy, claims to alleviate pain and boost immunity but lacks stringent regulatory oversight. We report a unique case of Tawon Liar-induced Immunoglobulin A (IgA) vasculitis and exacerbation of psoriasis, highlighting the potential dangers associated with misadvertised supplements.
A 53-year-old migrant worker from Mexico with a history of psoriasis and ankylosing spondylitis, effectively managed with adalimumab, presented with new-onset rashes on his extremities. Physical examination revealed palpable purpura on the lower legs and erythematous papules and plaques with pustules on the upper extremities. Dermoscopic analysis suggested IgA vasculitis and pustular psoriasis. The patient denied recent infections, new medications, or over-the-counter drug use. However, after thorough questioning, it was revealed that he had been intermittently ingesting Tawon Liar for chronic musculoskeletal pain. The supplement, obtained from a coworker, contained undisclosed ingredients including meloxicam, ketorolac, and dexamethasone. Laboratory tests ruled out renal involvement, and biopsies were not performed due to financial constraints. The patient was advised to discontinue Tawon Liar and was treated with topical corticosteroids, leading to substantial improvement and resolution of symptoms within one week.
This case underscores the potential dangers of herbal supplements containing hidden pharmacologic agents. It highlights the need for clinicians to diligently inquire about supplement use during patient evaluations, especially for vulnerable populations facing language barriers and limited access to healthcare. Public health authorities should enhance efforts to disseminate drug safety information across diverse languages and platforms to mitigate health risks associated with such products.
由于成分未公开，不受监管的草药补充剂可能会带来重大健康风险。“塔翁骗子”是一种在印度尼西亚销售的号称“全天然”疗法的产品，声称可缓解疼痛并增强免疫力，但缺乏严格的监管。我们报告了一例因“塔翁骗子”导致免疫球蛋白A（IgA）血管炎并加重银屑病的独特病例，突出了与虚假宣传的补充剂相关的潜在危险。
一名来自墨西哥的53岁农民工，有银屑病和强直性脊柱炎病史，此前使用阿达木单抗有效控制病情，此次因四肢出现新发皮疹前来就诊。体格检查发现小腿有可触及的紫癜，上肢有红斑丘疹及脓疱性斑块。皮肤镜分析提示IgA血管炎和脓疱型银屑病。患者否认近期有感染、服用新药或使用非处方药。然而，经过详细询问，发现他一直在断断续续地服用“塔翁骗子”来缓解慢性肌肉骨骼疼痛。该补充剂是从一名同事那里获得的，含有未公开的成分，包括美洛昔康、酮咯酸和地塞米松。实验室检查排除了肾脏受累，由于经济限制未进行活检。建议患者停用“塔翁骗子”，并给予外用糖皮质激素治疗，症状在一周内得到显著改善并消退。
本病例强调了含有隐藏药理成分的草药补充剂的潜在危险。它突出了临床医生在患者评估期间认真询问补充剂使用情况的必要性，特别是对于面临语言障碍和医疗服务获取有限的弱势群体。公共卫生当局应加大力度，通过多种语言和平台传播药物安全信息，以降低与此类产品相关的健康风险。
