Citation

Anwar M, Turner M, Farrell N, Zomlefer WB, McDougal OM, Morgan BW. Clin. Toxicol. (Phila) 2018; 56(9): 841-845.

Affiliation

f Emory University School of Medicine , Atlanta , GA , USA.

Copyright

(Copyright © 2018, Informa - Taylor and Francis Group)

DOI

10.1080/15563650.2018.1442007

PMID

29490507

Abstract

INTRODUCTION: Steroidal alkaloids are found in plants of the genus Veratrum. Their toxicity manifests as gastrointestinal symptoms followed by a Bezold-Jarisch reflex: hypopnea, hypotension, and bradycardia. Some Veratrum steroidal alkaloids are also teratogens interfering with the hedgehog-2 signaling pathway, which causes cyclopsia and holoprosencephaly. We present a case of accidental poisoning from Veratrum parviflorum mistaken for the edible Allium tricoccum (ramps, wild leek). CASE HISTORY: A 27-year-old man and his 25-year-old wife presented to the emergency department with nausea, vomiting, hypotension, and bradycardia after foraging and ingesting plants that they believed to be a local native species of wild leek.

METHODS: We collected and analyzed the implicated fresh plant material and both patients' serum/plasma. We used liquid chromatography-mass spectroscopy and high-resolution electrospray ionization time of flight tandem mass spectrometry to extract and characterize steroidal alkaloids from the foraged plant and patients' serum.

RESULTS: Our V. parviflorum samples contained verazine, veratramine, veratridine, and cyclopamine.

DISCUSSION: Steroidal alkaloids have been previously isolated from Veratrum viride and Veratrum album and toxicity has been reported mainly from V. album species.

CONCLUSION: V. parviflorum toxicity manifests with gastrointestinal and cardiac symptoms. Treatment is symptomatic and supportive as with previous case reports of toxicity with other Veratrum species.

Language: en

Keywords

Bezold–Jarisch; Steroidal alkaloid; Veratrum; cyclopamine; wild leeks