Can zucchini kill you?

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CONTEST DISCLAIMER

Case description

A 54-year-old healthy patient was admitted for sudden severe abdominal pain, vomiting, and hemorrhagic diarrhea. Upon admission, the patient was hypotensive. Laboratory tests revealed elevated levels of aminotransferases (alanine aminotransferase, 14.8 μkat/L; aspartate aminotransferase, 21.1 μkat/L) and leukocytosis (19.9 × 10⁹/L). Transaminase elevation was attributed to hypotension. To rule out unspecified intra-abdominal pathology, an abdominal computed tomography scan was performed. Liver vessel occlusion was not confirmed. Other pathological findings complicated the differential diagnosis. Besides thickening of the colon wall, there was significant periportal “cuffing” and subhepatic region swelling. Acute gastroenteritis, probably of infectious origin, was suspected by the attending physician. After volume expansion, the blood pressure normalized; however, intense pain and diarrhea persisted.

The disease course did not seem typical of infectious gastroenteritis. The etiology of the liver damage and intra-abdominal edema was unclear. “Cuffing” may accompany acute viral hepatitis, heart failure, or cholangitis; however, none of these conditions was subsequently not confirmed, nor does any of them involve hemorrhagic diarrhea. Therefore, the medical history was re-examined in detail. The symptoms started abruptly. Epidemiological history was negative. The patient had not consumed anything unusual except for baked zucchini with bread. She took no medications. The physicians contemplated what they might have overlooked.

The nurse who was taking care of the patient wondered if the issue could be related to the zucchini. Having spent more time with the patient, she learned that the zucchini tasted unusually bitter but that the patient did not consider this fact important enough to report. The nurse added that bitter zucchini should not be consumed, although she did not know why. Based on information obtained from ChatGPT and online resources, a diagnosis of cucurbitacin poisoning was proposed. From the third day onward, the patient was practically symptom-free, and aminotransferase levels normalized within 5 days. In cooperation with the Institute of Forensic Medicine and Toxicology in Prague, we planned to confirm the presence of cucurbitacin in the blood by gas chromatography. Unfortunately, the sample could not be found as the cleaning staff mistakenly considered it waste.

About Best Case Report Contest 2024

Young Talents in Internal Medicine World Contest—previously Best Case Report Contest—is a contest for internal medicine specialists or trainees in internal medicine up to 35 years of age. Every year the most engaging submissions from around the world are presented by authors during a special session at the McMaster International Review Conference of Internal Medicine (MIRCIM). Visit youngtalents.one to learn more.

To browse all abstracts from Best Case Report Contest 2024, visit Polish Archives of Internal Medicine.