Moringa Oleifera leaf extract induced pulmonary embolism-a case report

BACKGROUND: M. oleifera leaf extract supplement is famous for its anti-inflammatory, antioxidant, antimicrobial, antifertility, anticancer, antihepatotoxic, and antiulcer properties. However, limited data exist on the coagulation effect of M. oleifera leaf extract in human plasma, which maybe a predisposing factor to venous thromboembolism (DVT and PE); a disorder that is well known to be induced by risk factors such as surgery, trauma, cancer, or prolonged immobility. CASE PRESENTATION: We report a case of a 63-year-old Hispanic female with past medical history of obesity and type 2 diabetes mellitus who presented to the emergency room with a three-day history of worsening shortness of breath and chest pain. Computerized tomography-pulmonary angiogram (CT-PA) revealed bilateral pulmonary embolism (PE) and right ventricle strain. Based on CT imaging findings, the absence of a major transient risk factor for venous thromboembolism (VTE), no history suggestive of an underlying hypercoagulable disorder, and a medication history that was significant for a recent 5-month use of M. oleifera leaf extract that has been reported to induce clot formation, she was diagnosed as a rare case of sub-massive pulmonary embolism provoked by M. oleifera leaf extract supplement. She received initial anticoagulation (AC) during her hospitalization and was discharged on maintenance AC for 3 months. DISCUSSION AND CONCLUSION: We report the first case of PE likely triggered by using Moringa oleifera leaf extract herbal supplement. Cohort studies on the coagulation effect of Moringa oleifera leaf extract in humans are necessary to determine the relationship between Moringa Oleifera leaf extract and VTEs.