Case Presentation: Over 45,000 human plant exposures are reported in the United States annually. Ingestions occur frequently but serious toxicity is rare. Common ingestions include peace lily, poinsettia and holly, among others (Table 1). Less commonly, lily of the valley (Convallaria majalis) and crocus (Crocus sativus) are culprits (Figure 1).Crocus, the source of saffron, is a frequently used spice. The highest concentration of its toxic alkaloid, colchicine, is in the flowers and seeds. Such ingestion is rarely encountered which makes it a challenging diagnosis. We present a case of accidental crocus poisoning and its management.A 57-year-old woman presented with nausea, vomiting, diarrhea and weakness that began a day after ingesting foraged plants which she thought were wild onions. She denied any other systemic symptoms. On presentation she had normal vital signs but was ill-appearing and retching. Her exam was otherwise normal. Initial blood work revealed leukocytosis, an elevated hemoglobin, an elevated creatinine and transaminitis.The patient was treated with intravenous fluids and antiemetics. Blood was tested for digoxin given possible ingestion of lily of the valley, which appears similar to ramps, and colchicine levels. Cardiology was consulted and serial electrocardiograms were normal. Initial troponin level was 0.09 ng/mL (normal < 0.05 ng/mL), but normalized. A digoxin level was low. A colchicine level was positive at 1.3 ng/mL (normal < 0.2 ng/mL). An echocardiogram was unremarkable. Stool studies, urine drug screen, acetaminophen and salicylate levels were also negative. Her transaminitis also improved. The hospital course was complicated by progressive pancytopenia. Due to worsening neutropenia and thrombocytopenia, G-CSF and platelets were administered, with stabilization of these values. The patient improved and was discharged home on hospital day seven.
Discussion: When treating accidental ingestions, the plant may be unknown. Symptoms and laboratory data can assist in identifying the ingested plant and guide treatment.Multi-organ failure is characteristic of acute colchicine toxicity. The clinical course follows three phases. The first phase is characterized by leukocytosis, gastrointestinal symptoms and shock. The second stage occurs 24-72 hours after ingestion and can include arrhythmia, renal failure, hepatic injury and bone marrow suppression lasting up to one week. The third phase is characterized by leukocytosis and alopecia. Management is primarily supportive with consideration to treat any infectious complications and more intensive treatment should the patient deteriorate.
Conclusions: In summary, accidental plant ingestion may lead to severe illness. A detailed history, following symptoms and analyzing laboratory testing can help determine which toxic plant was ingested.
