Description of a fatal case of acute Phytolacca americana poisoning due to leaf ingestion in China

Le résumé fourni par la source

BACKGROUND: Phytolacca americana L. (American pokeweed), an alien plant species in China, has become widely distributed in both rural and urban areas. American pokeweed contains toxic substances such as saponins and oxalates, which have led to multiple poisoning incidents in recent years. Here, we describe a fatal case of acute American pokeweed leaf poisoning in China, emphasizing the clinical progression, toxin concentration, and implications for public health interventions. To our knowledge, no such description currently exists in the literature. METHODS: A comprehensive epidemiological investigation, morphological identification, and ultra-performance liquid chromatography-triple quadrupole/linear ion trap mass spectrometry (UPLC-Qtrap MS) analysis were conducted to confirm toxin exposure. Esculentoside A (EsA) and its metabolite phytolaccagenin (hEsA) were quantified in plant specimens and patient blood. RESULTS: A 50-year-old woman developed severe gastrointestinal symptoms 2 h after ingesting stir-fried pokeweed leaves (≈150 g raw), progressing to multi-organ failure and death within 33 h. Laboratory findings revealed metabolic acidosis (pH 7.11), hypovolemic shock, cardiac injury (troponin I: 12.70 ng/mL), and coagulopathy (D-dimer: 83.8 mg/L). UHPLC-Qtrap MS detected high concentrations of hEsA (the whole plant: 2.50 mg/kg, blood: 2.37 ng/mL) and EsA (the whole plant: 133 mg/kg, blood: 0.1 ng/mL). CONCLUSIONS: The present case highlights the fact that the lethal potential of improperly prepared pokeweed leaves. The predominance of hEsA in blood highlights the importance of metabolite detection in toxin analysis. This study has important reference value for the prevention and clinical treatment of similar poisoning incidents in the future.

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