Electrophysiological Findings in Acute Solanum Torvum Toxicity (P5.103)

Abstract

OBJECTIVE: To describe the electrophysiological findings in a patient with acute Solanum torvum (susumber berry) poisoning BACKGROUND: Solanum torvum, also known as the susumber or turkey berry, is an ingredient used in traditional Jamaican dishes. Berries are picked at various stages of maturation and boiled. Published cases are rare and toxicity may be related to maturity of berries or environmental stresses. The concentration of steroid glycoalkaloids found in berries linked to acute toxicity appears to be higher than that found in nontoxic berries. Steroid glycoalkaloids inhibit serum and erythrocyte acetylcholinesterase and butyrylcholinesterase and lead to clinical manifestations including gastrointestinal distress, cranial nerve abnormalities, and respiratory weakness. Electrophysiological findings have never been described in affected patients. DESIGN/METHODS: We present a case report from a tertiary medical center of a 54-year-old Jamaican female who obtained susumber berries bought in Jamaica and personally imported by a relative. She prepared and consumed a large number the night prior to presentation and was brought to the Emergency Department by Emergency Medical Services after progressive changes in vision, dizziness, speaking difficulty and muscle weakness. Neurological examination was notable for an intact mental status, opsoclonus, severe dysarthria, mild distal upper and lower extremity weakness with tenderness to palpation, delayed motor reflexes and marked ataxia. RESULTS: Magnetic resonance imaging of the brain and cerebrospinal fluid studies were unremarkable. Laboratory analysis was significant for a peak creatine kinase of 1886 IU/L. Electromyography studies demonstrated myotonia and early recruitment of motor units with a full interference pattern. With supportive care, the patient’s symptoms improved by hospital day #3 and she was discharged home in stable condition. CONCLUSIONS: Acute intoxication with poisonous Solanum torvum berries appears to cause a toxic myopathy. The chemical directly responsible remains unknown, however, is likely of the class of solanaceous steroidal glycoalkaloids. Study Supported by: None

Disclosure: Dr. Glover has nothing to disclose. Dr. Patterson has nothing to disclose. Dr. Connors has nothing to disclose. Dr. Smith has nothing to disclose. Dr. Milstein has nothing to disclose. Dr. Swerdlow has nothing to disclose.