Table 1 Studies on spirulin ingestion and autoimmune disease onset or flare
From: Spirulina ingestion and autoimmune disease onset or flare
Author, year, reference | Study design | N, age, gender | Disease | Spirulina dosage | Time to disease onset | Clinical features | Treatment | Outcome |
|---|---|---|---|---|---|---|---|---|
Kuzumi et al. 2024 [4] | Case report | 1, 60 yo, Female | Anti-Mi-2-positive dermatomyositis | Unknown | 1 month | Pruritus rash after 1 month of Spirulina ingestion 3 weeks after proximal muscle weakness and dysphagia Periungual erythema and nailfold bleeding CK of 4761 U/L and aldolase 31.1 U/L. Positive anti-Mi-1 antibody Electromyography-myopathy. Thorac CT: mild interstitiopathy Skin biopsy: interface dermatitis and perivascular infiltration, mucin deposition | Methylprednisolone pulse therapy -> 40 mg/day of prednisolone Monthly IVIg | Improved |
Konno et al. 2011 [5] | Case report | 1, 49 yo, Female | Myositis (probably dermatomyositis) | ND | Days | After taking Spirulina, she had a skin rash. After 5 months, she developed muscle weakness in her of the neck flexor and left proximal upper extremity. CK of 1,268 IU/ml Muscle biopsy: Many necrotizing muscle fibers, infiltration of mononuclear cells in the peri- and endomysium, including many eosinophils. Immunohistochemical: CD4-positive cells in the peri- and endomysium and CD20-positive B cells in the perivascular regions. | Prednisolone Cyclophosphamide Methylprednisolone pulse therapy | Improved |
Kraigher et al. 2008 [6] | Case series | 1, 82 yo, Female | Bullous pemphigoid and pemphigus foliaceus | ND | 1 year | Bullae, partly hemorrhagic, are present on the trunk and extremities, secreting erosions and submammary macerations. Positive Nikolsky. 1st biopsy: subepidermal bulla with a denuded surface and sparse perivascular lymphocytic infiltrate with scattered eosinophils. 2nd biopsy: intra- and subcorneal vesicular dermatitis with slight superficial acantholysis. Direct immunofluorescence: IgG and C3 at the dermoepidermal junction. Indirect immunofluorescence: positive at the dermo-epidermal junction. Salt split test: IgG, IgM, and C3 on the upper side of the bulla. No pemphigus autoantibodies. | Prednisone 60 mg/day and spirulin withdrawal. | She was cured after 3 months. |
Lee & Werth, 2004 [7] | Case series | 2 out of 3, Case 1: 57 yo male Case 2: 45 yo female | Case 1: Pemphigus flare Case 2: Dermatomyositis | Unknown. Case 3 ingested Aphanizomenon flos-aquae together with Spirulina. | Case 1: 7–10 days Case 2: 1–2 days | Case 1: A pemphigus flare was verified with a worse clinical picture that resolved after 2 weeks of stopping Spiruline and using prednisone. One week after this flare cleared, a second worse flare was observed. Case 2: erythema on the extensor arms, elbows, knuckles of the hands (Gottron’s sign), face, upper back, and neck. Positive ANA 1:160. Normal muscle enzymes. Skin biopsy: interface dermatitis and vacuolization. After 6 months: muscle weakness, CK 2018 U/L, aldolase 22.6 U/L. | Case 1: Spirulin stopping and prednisone. Case 2: Prednisone, hydroxychloroquine, tacrolimus ointment, and cetirizine. | Case 1: ND Case 2: ND |