{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T20:48:44Z","timestamp":1792702124670,"version":"4.5.0"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,5,15]],"date-time":"2020-05-15T00:00:00Z","timestamp":1589500800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,5,15]],"date-time":"2020-05-15T00:00:00Z","timestamp":1589500800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Indigo naturalis is a Chinese herbal medicine that has currently been used to treat various inflammatory diseases, including ulcerative colitis. Recently, there are several reports concerning severe adverse events associated with indigo naturalis.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Case presentation<\/jats:title>\n<jats:p>We described a case of a 44-year-old female with ulcerative colitis who presented with lower abdominal pain and hematochezia. She stopped taking her medicine for ulcerative colitis and started oral indigo naturalis 3\u00a0months before admission. Computed tomography showed segmental edematous wall thickening of the descending and sigmoid colon. Colonoscopy findings revealed erythema, edema, and submucosal hemorrhage, the surface of which presented a dark blue pigmentation. The histologic finding was consistent with ischemic colitis. We therefore considered an ischemic colitis induced by indigo naturalis, and the patient improved after supportive care and withdrawal of indigo naturalis.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Indigo naturalis has currently been used in the patients with ulcerative colitis as an alternative therapy. However, physicians should be aware of possible severe adverse events such as ischemic colitis.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12876-020-01301-3","type":"journal-article","created":{"date-parts":[[2020,5,15]],"date-time":"2020-05-15T12:48:58Z","timestamp":1589546938000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Ischemic colitis induced by indigo naturalis in a patient with ulcerative colitis: a case report"],"prefix":"10.1186","volume":"20","author":[{"given":"Byungha","family":"Cho","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3885-6763","authenticated-orcid":false,"given":"Soon Man","family":"Yoon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-Myoung","family":"Son","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyoung Woo","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ki Bae","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sei Jin","family":"Youn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,5,15]]},"reference":[{"issue":"9","key":"1301_CR1","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1007\/s00535-016-1220-2","volume":"51","author":"S Sugimoto","year":"2016","unstructured":"Sugimoto S, Naganuma M, Kanai T. Indole compounds may be promising medicines for ulcerative colitis. J Gastroenterol. 2016;51(9):853\u201361.","journal-title":"J Gastroenterol"},{"issue":"1","key":"1301_CR2","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1080\/25785826.2019.1599158","volume":"42","author":"M Naganuma","year":"2019","unstructured":"Naganuma M. Treatment with indigo naturalis for inflammatory bowel disease and other immune diseases. Immunol Med. 2019;42(1):16\u201321.","journal-title":"Immunol Med"},{"issue":"17","key":"1301_CR3","doi-asserted-by":"crossref","first-page":"2718","DOI":"10.3748\/wjg.v19.i17.2718","volume":"19","author":"H Suzuki","year":"2013","unstructured":"Suzuki H, Kaneko T, Mizokami Y, Narasaka T, Endo S, Matsui H, et al. Therapeutic efficacy of the Qing Dai in patients with intractable ulcerative colitis. World J Gastroenterol. 2013;19(17):2718\u201322.","journal-title":"World J Gastroenterol"},{"issue":"3","key":"1301_CR4","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1159\/000444217","volume":"93","author":"S Sugimoto","year":"2016","unstructured":"Sugimoto S, Naganuma M, Kiyohara H, Arai M, Ono K, Mori K, et al. Clinical efficacy and safety of oral Qing-Dai in patients with ulcerative colitis: a single-center open-label prospective study. Digestion. 2016;93(3):193\u2013201.","journal-title":"Digestion."},{"issue":"4","key":"1301_CR5","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1053\/j.gastro.2017.11.024","volume":"154","author":"M Naganuma","year":"2018","unstructured":"Naganuma M, Sugimoto S, Mitsuyama K, Kobayashi T, Yoshimura N, Ohi H, et al. Efficacy of indigo naturalis in a multicenter randomized controlled trial of patients with ulcerative colitis. Gastroenterology. 2018;154(4):935\u201347.","journal-title":"Gastroenterology."},{"issue":"16","key":"1301_CR6","doi-asserted-by":"crossref","first-page":"2299","DOI":"10.2169\/internalmedicine.2446-18","volume":"58","author":"J Urushikubo","year":"2019","unstructured":"Urushikubo J, Yanai S, Nakamura S, Kawasaki K, Akasaka R, Sato K, et al. Efficacy of indigo naturalis therapy for ulcerative colitis: a case series. Intern Med. 2019;58(16):2299\u2013304.","journal-title":"Intern Med"},{"issue":"25","key":"1301_CR7","doi-asserted-by":"crossref","first-page":"1992","DOI":"10.1093\/eurheartj\/ehw090","volume":"37","author":"M Nishio","year":"2016","unstructured":"Nishio M, Hirooka K, Doi Y. Chinese herbal drug natural indigo may cause pulmonary artery hypertension. Eur Heart J. 2016;37(25):1992.","journal-title":"Eur Heart J"},{"key":"1301_CR8","first-page":"265","volume":"26","author":"K Sato","year":"2019","unstructured":"Sato K, Ohira H, Horinouchi T, Nakaya T, Mazaki Y, Sugimoto A, et al. Chinese herbal medicine Qing-Dai-induced pulmonary arterial hypertension in a patient with ulcerative colitis: a case report and experimental investigation. Respir Med Case Rep. 2019;26:265\u20139.","journal-title":"Respir Med Case Rep"},{"issue":"3","key":"1301_CR9","doi-asserted-by":"crossref","first-page":"395","DOI":"10.2169\/internalmedicine.1523-18","volume":"58","author":"K Misumi","year":"2019","unstructured":"Misumi K, Ogo T, Ueda J, Tsuji A, Fukui S, Konagai N, et al. Development of pulmonary arterial hypertension in a patient treated with qing-dai (Chinese herbal medicine). Intern Med. 2019;58(3):395\u20139.","journal-title":"Intern Med"},{"issue":"4","key":"1301_CR10","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1007\/s12328-018-0851-7","volume":"11","author":"S Kondo","year":"2018","unstructured":"Kondo S, Araki T, Okita Y, Yamamoto A, Hamada Y, Katsurahara M, et al. Colitis with wall thickening and edematous changes during oral administration of the powdered form of Qing-dai in patients with ulcerative colitis: a report of two cases. Clin J Gastroenterol. 2018;11(4):268\u201372.","journal-title":"Clin J Gastroenterol"},{"issue":"6","key":"1301_CR11","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1111\/den.13226","volume":"30","author":"S Yanai","year":"2018","unstructured":"Yanai S, Nakamura S, Matsumoto T. Indigo naturalis-induced colitis. 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Gastroenterology. 2017;152(2):415\u201329.","journal-title":"Gastroenterology."}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-020-01301-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12876-020-01301-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-020-01301-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,14]],"date-time":"2021-05-14T23:15:10Z","timestamp":1621034110000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgastroenterol.biomedcentral.com\/articles\/10.1186\/s12876-020-01301-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,15]]},"references-count":14,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1301"],"URL":"https:\/\/doi.org\/10.1186\/s12876-020-01301-3","relation":{},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,15]]},"assertion":[{"value":"13 March 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 May 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 May 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Authors\u2019 institution does not require ethical approval for publication of a single case report. Written informed consent was obtained from the patient.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and the accompanying images. A copy of the written consent is available upon request.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"154"}}