Massive fatal overdose of abrin with progressive encephalopathy*

B (Zane) Horowitz, Rachel Castelli, Adrienne Hughes, Robert Hendrickson, Rudolph C. Johnson, Jerry D. Thomas

Research output: Contribution to journalArticle

Abstract

Introduction: The jequirity bean (Abrus precatorius) seed contains abrin, a toxalbumin, that irreversibly binds the 60-s ribosomal subunit inhibiting protein synthesis. Neurologic manifestations of ingestions are rare. Case details: We present a case of a 20-year-old man with 24 h of vomiting, diarrhea and 2 h of hematemesis and hematochezia. He admitted to purchasing 1000 jequirity beans online, crushing and ingesting them 26 h prior to presentation in a suicide attempt. Over the next 2 days, he developed hallucinations, incomprehensible mumbling and grunting, disconjugate gaze with abnormal roving eye movements and a left gaze preference with his right eye deviated medially. There was a fine tremor of the upper extremities and he had brief episodes of choreoathetoid movements of his legs. A head CT was normal with no cerebral edema. He progressed to minimally responsive to noxious stimuli, and was unable to converse or follow commands and displayed increased choreoathetoid movements of his extremities. An electroencephalogram (EEG) showed only mild background slowing. Magnetic resonance imaging (MRI) was performed showing bilaterally symmetric signal abnormalities in the basal ganglia, brainstem, corpus callosum and corona radiata with diffuse leptomeningeal enhancement. The patient developed a tonic–clonic seizure followed by pulseless electrical activity, from which he was resuscitated. He was provided comfort care and died just under 5 days after his ingestion. Results: Urine analysis using liquid chromatography coupled to tandem mass spectrometry was positive for 8.84 ng/ml of l-abrine (4.96 ng l-abrine/mg creatinine) 61 h after admission to the hospital (approximately 87 h post-ingestion). Serum concentrations for l-abrine and ricinine were both below the limits of detection. Discussion: Ingestion of 1000 crushed jequirity beans purchased on the internet resulted in progressive encephalopathy and death.

Original languageEnglish (US)
JournalClinical Toxicology
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Abrin
Brain Diseases
Eating
Abrus
Eye movements
Liquid chromatography
Crushing
Purchasing
Electroencephalography
Hematemesis
Ribosome Subunits
Magnetic resonance imaging
Gastrointestinal Hemorrhage
Mass spectrometry
Seed
Corpus Callosum
Hallucinations
Creatinine
Brain Edema
Tremor

Keywords

  • Abrin
  • abrine
  • jequirity bean

ASJC Scopus subject areas

  • Toxicology

Cite this

Massive fatal overdose of abrin with progressive encephalopathy* . / Horowitz, B (Zane); Castelli, Rachel; Hughes, Adrienne; Hendrickson, Robert; Johnson, Rudolph C.; Thomas, Jerry D.

In: Clinical Toxicology, 01.01.2019.

Research output: Contribution to journalArticle

Horowitz, B (Zane) ; Castelli, Rachel ; Hughes, Adrienne ; Hendrickson, Robert ; Johnson, Rudolph C. ; Thomas, Jerry D. / Massive fatal overdose of abrin with progressive encephalopathy* In: Clinical Toxicology. 2019.
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