Scientists highlight zucchini poisoning case

A case report on a woman who fell sick after eating a zucchini has highlighted the importance of getting an accurate medical history and the role of nurses in making a diagnosis.

A 54-year-old woman with a history of epilepsy was admitted to an emergency department due to suspected gastrointestinal bleeding. She complained of abrupt, severe abdominal pain lasting for 10 hours, accompanied by vomiting and bloody, watery diarrhea. She denied having consumed unusual food products and had no history of pre-existing medical conditions. During the physical examination, the patient appeared exhausted. Her stool was watery and pinkish.

She was admitted to the intensive care unit with a diagnosis of acute gastroenteritis with dehydration, likely of infectious origin. After treatment, blood pressure normalized but intense abdominal pain persisted, along with pink watery diarrhea.

Bitter zucchini clue

According to the report, published in the Polish Archives of Internal Medicine, doctors were puzzled by the sudden onset of hemorrhagic diarrhea, accompanied by unusually intense abdominal pain and liver damage, in an otherwise healthy person with a negative epidemiological and drug history.

After retaking the patient’s medical history, doctors found she had not consumed anything unusual except for baked zucchini with bread and took no medications. The nurse looking after the patient suggested the issue could be related to the zucchini. Having spent more time with the woman, she learned that the zucchini tasted unusually bitter, but the patient did not consider this fact important enough to report. 

Based on information from ChatGPT and online resources, a diagnosis of cucurbitacin poisoning was proposed. The Czech Toxicological Information Center in Prague confirmed the suspicion. The next day, infectious diarrhea was ruled out. The patient was practically symptom-free on the third day since admission.

With the Institute of Forensic Medicine and Toxicology in Prague, scientists planned to confirm the presence of cucurbitacin in blood using gas chromatography. Unfortunately, the sample could not be found as the cleaning staff mistakenly considered it waste.

Cucurbitacins are a diverse family of organic compounds found in edible plants such as zucchini, pumpkin, cucumber, and others. These plants produce cucurbitacins in response to environmental stress, such as poor growing conditions, and levels of these compounds decrease during maturation.

In a French study of 353 individuals from 2012 to 2016, 95 percent of patients experienced mild poisoning. Symptoms typically appear within minutes to hours following ingestion, and mostly involve gastrointestinal complaints, such as nausea, vomiting, abdominal cramps, and diarrhea.

“Diagnosis relies mostly on clinical presentation, emphasizing careful history-taking. Physicians should consider cucurbitacin toxicity in patients presenting with symptoms shortly after ingesting plants from the Cucurbitaceae family. It is important to ascertain whether the plant tasted unusually bitter. This case shows that a properly taken medical history is crucial in the diagnostic process, especially in unclear situations,” said researchers.

Fatal case

Another study reported on a fatal case of food poisoning due to cucurbitacin in a zucchini, also known as a courgette.

Dutch researchers presented the case earlier this year at the International Congress of Therapeutic Drug Monitoring and Clinical Toxicology in Banff, Canada.

The incident involved an older, formerly healthy couple. Both patients had a maximum of two bites of a dish containing zucchini grown from their home garden. Two hours after ingestion, the woman contacted the general practice service (GPS) with symptoms of nausea, vomiting and diarrhea, which were more severe in the man. She also mentioned a repulsive bitter taste.

The couple was told to maintain fluid balance and contact the GPS if symptoms worsened. The next day, the woman had recovered, but her husband was still suffering from severe gastrointestinal distress. A home visit was planned, but by the time the GP visited the patient, he had died from exhaustion and dehydration less than 24 hours after eating the casserole.

The leftover material from the casserole and courgettes from the home garden were analyzed. The casserole and home garden zucchini contained cucurbitacin-E, cucurbitacin-E-glucoside, and cucurbitacin-I-glucoside, contrary to control courgettes from another home garden.

“We present this case to alert physicians of this rare but potentially fatal cause of food poisoning. The medical terminology food poisoning leads to a diagnosis of bacterial gastroenteritis, which is inadequate in the case of poisoned food,” said scientists.

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Source: https://www.foodsafetynews.com/2024/11/scientists-highlight-zucchini-poisoning-case/