BITTER LEMON MAY HAVE BITTER RESULTS

Purpura occurred in a patient already sensitised to quinine A 16-year-old girl was admitted to hospital with severe epistaxis, extensive purpura and petechiae. Six days earlier she felt w~k and shivery when she awoke and later developed purpuric haemorrhages on her arms, face and legs. Six weeks earlier she had taken quinine sulphate tablets irregularly for nocturnal leg c~amps. On admission her spleen was enlarged and platelet count was 15x I 09 /L. She was given a platelet transfusion and 40mg prednisolone daily. The platelet count became normal within 48 hours, she was discharged after I week and warned to avoid quinine. Six days later a similar episode occurred and although the patient denied taking quinine she admitted drinking a glass of bitter lemon. This drink was later found to contain 20pg quinine/ml although this was not indicated on the label. She remained on 20ing prednisolone daily and quickly recovered. In vitro testing confIrmed that the thrombocytopenia was due to quinine-dependent platelet antibodies which reacted to a threshold quinine concentration of 35 pg / ml.

'Quinine is one of the commonest drugs responsible for drug-induced pur­pura . . . minute amounts can induce severe thrombocytopenia in a previously sensitised person. We .. . think that all products containing quinine should be ap­propriately labelled.'

Murray, J.A. et aI .: British Medical Journal 2: 1551 (\ 5 Dec 1979)

0156-2703/ 80/ 0119-0007 $00.50 / 0 © ADIS Press INPHARMA 19Jan 1980 7