Acute abrin poisoning treated with continuous renal replacement therapy and hemoperfusion successfully: A case report.

RATIONALE: Abrin is a highly toxic protein obtained from the seeds of Abrus precatorius, but poisoning due to ingestion of A precatorius is extremely rare in China. PATIENT CONCERNS: A 16-year-old girl, perfectly healthy before, was admitted to the department of gastroenterology owing to intentional ingestion of 10 crushed A precatorius seeds, with multiple episodes of somnolent and anxious mental status, vomiting, abdominal pain, diarrhea, hematochezia, and hematuria. DIAGNOSIS: Acute abrin poisoning. INTERVENTIONS: We immediately took effective measures including gastric lavage, purgation, gastric acid suppression by proton pump inhibitor (PPI), liver protection, hemostasis, blood volume and electrolytes resuscitation, continuous renal replacement therapy (CRRT), and hemoperfusion (HP). OUTCOMES: Her unwell mental status was improved to the point at which she became conscious and relaxed. The symptoms of vomiting, abdominal pain, diarrhea, hematochezia, and hematuria disappeared gradually. The girl eventually made an excellent recovery with no complications at her 3-month follow-up. LESSONS: The combination of CRRT and HP is an efficient measure in the treatment of abrin poisoning for which there is no specific antidote. This is the first reported case of an abrin poisoning patient successfully treated by CRRT plus HP. Our experience will be useful to other physicians in managing patients of acute abrin poisoning in the future.

A chimeric protein of abrin and Abrus precatorius agglutinin that neutralizes abrin mediated lethality in mice.

Abrin, a type II ribosome inactivating protein from the Abrus precatorius plant, is extremely toxic. It has been shown to be 75 times more potent than its infamous sister toxin, ricin and their potential use in bio-warfare is a cause of major concern. Although several vaccine candidates are under clinical trials for ricin, none are available against abrin. The present study proposes a chimeric protein, comprising of 1-123 amino acids taken from the A chain of abrin and 124-175 amino acids from Abrus precatorius agglutinin A chain, as a vaccine candidate against abrin intoxication. The design was based on the inclusion of the immunogenic region of the full length protein and the minimal essential folding domains required for inducing neutralizing antibody response. The chimera also contains the epitope for the only two neutralizing antibodies; D6F10 and A7C4, reported against abrin till now. Active immunization with the chimera protected all the mice challenged with 45 X LD50 of abrin. Also, passive transfer of antibodies raised against the chimera rescued all mice challenged with 50 X LD50 of toxin. Hence the chimeric protein appears to be a promising vaccine candidate against abrin induced lethality.

Abrin poisoning in an 18-month-old child.

BACKGROUND: When discussing known poisons and their clinical consequences, few physicians are aware of the deadly poison abrin. The common symptoms of abrin toxicity include nausea, vomiting, abdominal pain, and diarrhea with or without bloody stool. However, with an estimated fatal human dose of less than 1 microgram/kg, death due to complications such as liver failure, renal failure, and cerebral edema are possible. CASE REPORT: An 18-month-old male presented to the emergency department with an abrupt onset of fever, vomiting, diarrhea, and dehydration. The parents had assumed the child was suffering from a severe gastroenteritis until they noticed 3 consecutive diapers containing colorful seeds that were identified by poison control as belonging to the Abrus precatorius plant. The child's gastrointestinal symptoms were consistent with reported cases of abrin poisoning, but the patient also had an isolated and significantly elevated alkaline phosphatase, with testing unable to reveal the responsible pathological process. CONCLUSIONS: To reduce morbidity and possible mortality, parents and pediatricians alike should be conscious of the danger the Abrus precatorius seed poses to the pediatric population. Children are at a greater risk of ingesting these seeds due to their colorful appearance, and the consequences could be fatal. Through this case report we hope to raise public awareness regarding this toxin. This includes the management of known cases, as well as the possibility of encountering an isolated elevated alkaline phosphatase level as a laboratory finding if ingestion occurs.

Attempted suicide, by mail order: Abrus precatorius.

OBJECTIVE: Abrus precatorius is cultivated in many subtropical areas. The seeds exist in a variety of colors such as black, orange, and most commonly, glossy red. A black band is found at the end of the seed. The plant contains multiple pods which typically contain three to five Abrus seeds. The seeds contain abrin, which inhibits ribosomal function, halting protein synthesis and leading to cellular death. A unique aspect of this case is the use of the internet to order a potentially lethal poison as well as transmission of a picture to identify the seed. CASE REPORT: A 20-year-old man presented to the emergency department complaining of vomiting and watery diarrhea for 6-8 h prior to arrival. He denied any medication use, recent illness, travel, or changes in his diet. Initial vital signs were normal. The patient was diagnosed with viral gastroenteritis. During his evaluation, the patient admitted to feeling suicidal. While awaiting psychiatry evaluation, the patient's father arrived with a box of small hard red seeds, which he believed that his son ingested in a suicide attempt. The seeds could not be identified by the staff. A picture of the seeds was transmitted by e-mail to the New York City Poison Control Center, allowing their identification as A. precatorius. The patient was reinterviewed and admitted to chewing and swallowing 10 seeds. Given the potential toxicity of abrin, the patient was admitted to the intensive care unit. He continued to have frequent episodes of emesis as well as diarrhea. He gradually improved over 2 days. He admitted to ordering a box of Abrus seeds online from Asia after reading on the Internet about their use in suicide. He was eventually discharged for outpatient follow-up with no permanent sequelae. CONCLUSION: Abrin has an estimated human fatal dose of 0.1-1 µg/kg. Most cases of Abrus seed ingestions are unintentional and occur in children. Ingesting the intact seeds typically results in no clinical findings, as they pass through the gastrointestinal tract due to their hard shell. Abrin released during chewing is poorly absorbed systemically from the gastrointestinal tract. This causes the vomiting and diarrhea with resultant hypovolemia and electrolyte disturbances, which can be severe and life threatening, particularly in areas with less advanced health care systems. Management is primarily supportive.

Quantification of L-abrine in human and rat urine: a biomarker for the toxin abrin.

Abrin is a toxic protein found in the jequirity seed. L-Abrine (N-methyl-tryptophan) is also found in the jequirity seed and can be used as a biomarker for abrin exposure. Analysis of L-abrine was added to an existing method for quantifying ricinine as a marker for ricin exposure in human urine and analytically validated. Accuracy and reproducibility were enhanced by including a newly synthesized (13)C(1)(2)H(3)-L-abrine internal standard. One-milliliter urine samples were processed using solid-phase extraction prior to a 6-min high-performance liquid chromatography separation. Protonated molecular ions were formed via electrospray ionization in a triple-quadrupole mass spectrometer and quantified via multiple reaction monitoring. Method validation included the characterization of two enriched urine pools, which were used as quality control materials. Endogenous levels of L-abrine were quantified in a reference range of 113 random urine samples at 0.72 +/- 0.51 ng/mL. Urinary concentrations of L-abrine were monitored in an intentional rat exposure study for up to 48 h. Comparing the results from the human reference range and the animal exposure study indicates that this method is suitable for quantifying L-abrine within 24 h post-exposure. Quantification of L-abrine beyond 24 h is limited by rapid excretion of the biomarker and the level of the L-abrine dose.

Acute demyelinating encephalitis due to Abrus precatorius poisoning--complete recovery after steroid therapy.

INTRODUCTION: Poisoning from Abrus precatorius is attributed to a toxalbumin (abrin) that acts by inhibiting protein synthesis and rarely can cause immuno-mediated demyelination. We report a case of abrin poisoning with demyelination. CASE REPORT: A 19-year-old man presented with a history of ingesting crushed Abrus precatorius seeds following a family quarrel. He developed vomiting, abdominal pain, and bloody diarrhea, followed by a seizure and an altered sensorium. Magnetic resonance imaging (MRI) of the brain showed demyelination in the bilateral-medial temporal lobes. The patient was treated with supportive care, and intravenous methylprednisolone followed by oral prednisone, and recovered fully. DISCUSSION: Abrin is an immuno-modulator that may cause immune-mediated demyelination. We report the clinical course of a patient with demyelination after abrin poisoning, treated with corticosteroids, and document his clinical recovery. CONCLUSION: Demyelination is a rare complication of Abrus precatorius poisoning. In our case, the demyelination was demonstrated by MRI. Although our patient appeared to recover completely following methylprednisolone therapy, the suggestion that methylprednisolone or other corticosteroids might be useful in treating this demyelination needs experimental verification and clinical validation before concluding that it is a beneficial therapy.

An unusual manifestation of Abrus precatorius poisoning: a report of two cases.

Abrus precatorius seeds are highly toxic and are often ingested as a means of suicide in India. Hemorrhagic gastroenteritis with erosions, hemolysis, acute renal damage, hepatotoxicity with elevated liver enzymes, and seizures are common manifestations of toxicity. We report two cases of Abrus precatorius poisoning with raised intracranial pressure (ICP) and papilledema that have not been described earlier in literature. One patient recovered completely with conservative management to lower raised ICP while the other patient expired before effective treatment could be institutedd. The cases are being reported to propose the need for routine fundus examination and brain imaging in severe abrus poisoning with CNS toxicity, as early institution of treatment for cerebral edema measures may be life saving.

Acute demyelinating encephalitis after jequirity pea ingestion (Abrus precatorius).

INTRODUCTION: Castor and jequirity beans are uncommon causes of poisoning. The more common but less severe castor poisoning is well described, but jequirity bean (Abrus Precatorius) poisoning is rare. The toxicity is attributed to toxalbumins (ricin and abrin) that act by inhibiting protein synthesis. Their use as agents of biological warfare, mechanisms of action, and clinical features of poisoning are summarized. CASE REPORT: A 30-year-old previously healthy female presented with bloody diarrhea and deep coma following ingestion of 3-4 seeds of a plant called 'ratti.' Investigations, including an MRI brain scan, showed evidence of acute demyelinating encephalitis. The patient died three days later due to progressive central nervous system depression. DISCUSSION: This is a previously unreported manifestation of jequirity bean poisoning. Demyelination is immune-mediated, and Abrus is a well-known immuno-modulator and stimulator. A possible immunological pathogenic mechanism is hypothesized.

Poisoning due to white seed variety of Abrus precatorius.

We report an unusual case of poisoning involving the white seed variety of Abrus precatorius that caused serious manifestations in a middle-aged male who had consumed the seeds on the advice of a folk medicine practitioner. He recovered after a prolonged duration of hospital treatment without any subsequent complications or sequelae. The case is being reported on account of its rarity.

Poisoning due to Abrus precatorius (jequirity bean).

The management of a patient with poisoning due to ingestion of the jequirity bean (Abrus precatorius) is presented. The clinical features of this case included pulmonary oedema and hypertension; this has not been recorded previously in the literature associated with jequirity bean poisoning.