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Myocarditis from the Chinese Sumac Tree

John D. Bisognano, MD, PhD; Kevin S. McGrody, MD; and Abraham M. Spence, BA
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From University of Rochester Medical Center, Strong Memorial Hospital, Rochester, NY 14642.


Potential Financial Conflicts of Interest: None disclosed.


Ann Intern Med. 2005;143(2):159-160. doi:10.7326/0003-4819-143-2-200507190-00031
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Chinese Herbs and Myocarditis: Don't Throw Out the Baby with the Bath Water
Posted on July 25, 2005
Tsung O. Cheng
Georger Washington University
Conflict of Interest: None Declared

The Chinese sumac tree (Ailanthus altissima), or commonly known as the Tree of Heaven because of its rapid growth reaching the heaven faster than other trees, is also called stinking sumac because the flowers of the male tree have an unpleasant odor. It contains quassinoids that may cause myocarditis, as was described in this interesting case report by Bisognano and associates [1]. On the other hand, this tree has become very popular in the United States, because of the beneficial effect of quassinoids as a herbal remedy for amebic dysentery [2], malaria [3], Epstein-Barr virus infection [4], HIV infection [5], cancer [6] and tuberculosis [7].

Other herbal medicines are being used for treating viral myocarditis [8]. According to a recent Cochrane Central Register of Controlled Trials (CENTRAL) search, 25 different herbal medicines were tested [8]. Some herbal medicines, such as astragalus membranaceus (either as single herb or compound of herbs) and salviae miltiorrhizae injection showed significant anti-arrhythmic effects in suspected viral myocarditis [8]. Shenmai and Shengmai injection (Ginseng preparation) showed significant effects on reducing myocardial enzymes and improving cardiac function with no serious adverse effects [8].

Tsung O. Cheng, MD, FACP Professor of Medicine George Washington University Washington, D.C. 20037

References (1) Bisognano JD, McGrody KS, Spence AM: Myocarditis from the Chinese sumac tree. Ann Intern Med 2005;143: 159-160. (2) Calzado-Flores CC, Segura-Luna JJ, Dominguez XA, Garcia-Gonzalez S: Castela texana: screening for its anti-amoebic activity. Arch Invest Med 1986;17 Suppl 1:127-134. (3) Okunade AL, Bikoff RE, Casper SJ, Oksman A, Goldberg DE, Lewis WH: Antiplasmodial activity of extracts and quassinsoids isolated from seedlings of Aitanthus altissima (Simaroubaceae). Phytother Res 2003;17:675-677. (4) Tamura S, Fukamiya N, Okano M, Koyama J, Koike K, Tokuda H, et al: Three new quassinoids, ailantinol E,F, and G, from Aitanthus altissima. Chem Pharm Bull (Tokyo) 2003;51:385-389. (5) Chang YS, Woo ER: Korean medicinal plants inhibiting to human immunodeficienty virus type 1 (HIV-1) fusion. Phytother Res 2003;17:426- 429. (6) Rosati A, Quaranta E, Ammirante MN, Turco MC, Leone A, De Feo V: Quassinoids can induce mitochondrial membrane depolarisation and caspase 3 activation in human cells. Cell Death Differ 2004;11 Suppl 2:S216-S218. (7) Rahman S, Fukamiya N, Okano M, Tagahara K, Lee KH: Anti-tuberculosis activity of quassinoids. Chem Pharm Bull (Tokyo) 1997; 45:1527-1529. (8)Liu JP, Yang M, Du XM: Herbal medicines for viral myocarditis. Cochrane Database Syst Rev 2004;(3):CD003711.

Conflict of Interest:

None declared

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