Cardamom ingestion as a possible cause of hematuria.

Sir,Hematuria in childhood is a common clinical entity whichneeds an extensive evaluation.A 5-year-old girl admitted to our Pediatric Departmentbecause of isolated hematuria without any flank discomfort.The patient denied having fever, infections or any trauma inpreviousmonths. Therewas no family history of urinary stonesor bleeding diathesis. The patient took no medication. Herphysical examination was unremarkable. The child wasafebrile and normotensive. Initial laboratory evaluationrevealed an hemoglobin concentration of 12.5 g/dL, plateletcount of 370.000/mm3, white blood cells count of 8.370/mm3,and creatinine level of 0.7 mg/dL. An urinalysis revealed 88to 100 red blood cells (RBCs) per hpf, more than 25dysmorphic RBCs, more than 5% of acanthocytes and nourinary casts or crystals. Coagulation profile, cistatin C,complement and serum IgA were negative. Twenty four-hoururinalysis revealed normal values of protein and albumin,sodium potassium and calcium. Renal and bladder ultrasonographyshowed normal appearing of kidneys and bladder.Hematuria spontaneously disappeared within 1 day.A new analysis of the patient’s history demonstrated theintake of cardamom ice cream during dinner before admission.After discharge, a cardamom-free diet was prescribedand laboratoristic follow up was performed. Urinary sticks,daily performed during the first 2 wks after discharge and thenwkly for the following months, always resulted negative.Urinalysis carried out at 1, 3 and 6 months after hospitalization,did not show further episodes of hematuria and the childdidn’t show other clinical signs or symptoms.Isolated hematuria among children often needs extensiveevaluation, since differential diagnosis contemplates a largespectrum of etiologic factors including infections, stones,trauma, cancer, foods, drugs and other substances [1, 2].It has recently been demonstrated that cardamom(Elettariacardamomum), a highly aromatic spice, is able to inhibitplatelet aggregation, blocking the calcium transport acrossplatelet membranes. Moreover cardamom compete withagonists for interaction with glycoproteins IIb–IIIa, notallowing the adherence of fibrinogen and it also interfereswith the inhibition of adenylate cyclase activity and intraplateletcAMP levels [3]. Furthermore, it has been highlightedthat other spices and herbals are associated with anincreased risk of bleeding by inhibiting platelet function [4].Considering these findings, it is reasonable to hypothesizethat an excessive intake of cardamom may represent arisk factor for the development of hemorrhagic disorders.So physicians should ensure that patients receiving anticoagulantand antiplatelet medications, do not simultaneouslyassume cardamom. Our case would represent the first reportof cardamom ingestion as a possible cause of hematuria.Further trials are required to investigate about safety ofcardamom and other spices, in order to avoid the developmentof possible side effects.