SHM Converge Scientific Abstract ePoster Gallery-A Bitter Fruit: Multiple Organ Failure Following Ackee Ingestion

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This case report describes a 44-year-old man who developed severe multiorgan toxicity after eating ackee fruit. He presented five days after ingestion with persistent nausea, vomiting, abdominal pain, dehydration, and later worsening neurologic and cardiac symptoms. Although ackee poisoning classically causes “Jamaican vomiting sickness” with gastrointestinal symptoms and hypoglycemia, this patient progressed to acute kidney injury, liver injury with hepatic steatosis, encephalopathy, thyroid abnormalities, and marked cardiac injury.<br /><br />During hospitalization, he developed lethargy, nystagmus, and asterixis. Troponin levels rose significantly, ECG showed persistent ST changes, and echocardiography revealed new left ventricular dysfunction with an ejection fraction of 30%. Cardiac catheterization demonstrated normal coronary arteries, making obstructive coronary disease unlikely and supporting stress cardiomyopathy (Takotsubo syndrome) or type 2 myocardial injury. He was treated supportively with IV fluids, sodium bicarbonate, riboflavin, and close monitoring in the MICU, then improved and was discharged on day 10.<br /><br />The report explains that ackee toxicity is caused by hypoglycin A and hypoglycin B, which are heat-stable toxins found in unripe fruit and seeds. Hypoglycin A impairs beta-oxidation of fatty acids, leading to energy depletion and microvesicular steatosis, similar to Reye syndrome. Symptoms typically begin 6–48 hours after ingestion and can rapidly progress to seizures, coma, multiorgan failure, and death.<br /><br />The authors emphasize that clinicians should maintain a high index of suspicion for more than just hypoglycemia and vomiting in ackee poisoning, as it can cause rapid deterioration with encephalopathy, kidney failure, hepatic injury, and cardiac involvement. Early recognition and supportive care are critical, and recovery is usually possible within a week if the patient survives the acute phase.

Asset Subtitle

Elizabeth Beveridge

Meta Tag

Author List Allison Weiss, Dustin T. Smith, Elizabeth Beveridge, Julia Ossi, Lauren Cancio

Category Clinical Vignettes

Concept Ackee Fruit Toxicity

Concept Hypoglycemia

Concept Supportive Care

Concept Hypoglycin A

Concept Fatty Acid Beta-Oxidation

Distinguished Non-Finalist

Presenter Organization Emory School of Medicine

Presenting Author Elizabeth Beveridge

Track Adult

Keywords

ackee poisoning

hypoglycin A

Jamaican vomiting sickness

multiorgan toxicity

acute kidney injury

hepatic steatosis

encephalopathy

Takotsubo syndrome

cardiac injury

supportive care

Ackee Fruit Toxicity

Hypoglycemia

Supportive Care

Hypoglycin A

Fatty Acid Beta-Oxidation