KEY POINTS
- Case report of a 72-year-old woman with radiation necrosis after stereotactic radiotherapy for a brain metastasis in the right precentral gyrus.
- The original brain metastasis was treated with stereotactic radiotherapy to 35 Gy in 5 fractions; later imaging and symptoms were felt to favor radiation necrosis rather than progression.
- She was advised to take Boswellia serrata 4,500 mg once daily, but later reported she may have taken twice the instructed dose; she stopped it on day 8 after fatigue, headaches, palpitations, dizziness, and body aches.
- One week after discontinuation, serum creatinine had risen to 141 µmol/L from a baseline of 60 µmol/L; kidney function gradually normalized over the following month after emergency department assessment, intravenous fluids, and monitoring.
- Evidence for Boswellia serrata in radiation necrosis remains limited: one randomized trial in radiation-related cerebral edema used 4,200 mg/day, and one single-arm radiation necrosis cohort used 4,050-4,500 mg/day for at least 2 months.
CLINICAL TAKEAWAY
This case does not prove that Boswellia serrata causes acute kidney injury, but it is a useful warning about unsupervised high-dose supplement use in neuro-oncology. For patients using Boswellia serrata for radiation necrosis, clinicians should confirm the exact product, dose, frequency, and adverse effects, and consider renal monitoring, especially because efficacy and safety data remain limited.