Susumber Berries, A Bitter Experience

Abstract

Abstract only INTRODUCTION: Susumber Berry (Solanum torvum) is a green, bitter tasting berry used in Jamaican foods. It is also known as devilas fig, fausse aubergine, gully bean, sundakkai, thai eggplant, turkey berry, and soda apple. Rarely, berries can become toxic when environmentally stressed. We report two cases with susumber berriesa toxicity. CASE PRESENTATION: A Jamaican couple, 65 year old husband and 49 year old wife, presented almost 11 hours after having a meal that contained Susumber Barriers. These berries were brought to them by a friend from Jamaica. Berries were picked fresh from a tree, brought into USA via a flight and were kept frozen for almost a month before preparation. Berries were boiled and served with cod fish. Wife consumed 4 ounces and husband consumed around 8 ounces. Next morning, wife woke up with dizziness, facial weakness, inability to open eyes, blurring of vision, hoarseness, slowing of speech, nausea, vomiting and abdominal cramping. She woke up her husband who had more severe weakness and was not able to get up from the bed. The couple rushed to emergency. On arrival, both were noted to have elevated blood pressures (husband peaked at 210/110 and wife at 180/117 mmHg) and slow heart rate (in 60s). They had generalized weakness (more prominent in distal muscles of upper extremities), opsoclonus, past pointing and unsteady gait. Vital Capacity (VC) and Negative Inspiratory Force (NIF) were measured for detection of respiratory failure. Next day, their weakness resolved. Husbandas VC improved from 1.5 to 2.8 Liters and NIF improved from -20 to -43 cmH2O. Wifeas VC increased from 1.8-3.6 and NIF from -40 to -89. However, both were noted to have rhabdomyolysis (CK up to 39,000 in husband) and transaminitis (AST up to 1042 in wife). Patients left the ICU on Day 3 after complete resolution of symptoms and with a favorable trend in their laboratory values and remained stable thereafter. DISCUSSION: Toxic susumber berries contain solanaceous steroidal glycoalkaloids: solamargine and solasonine that have anti acetyl and butryl cholinesterase activity. Toxic berries do not differ in shape and taste from non-toxic ones. Toxicity is dose dependent. Presentation is similar to organophosphate poisoning. Only two outbreaks have been reported in literature. Both involved family meals and involved 5-6 family members. Most severe case developed ventilator dependent respiratory failure for 27 days. This case was associated with rhabdomyolysis. In our patients, degree of rhabdomyolysis was more severe; however they did not develop respiratory failure. CONCLUSIONS: Recognition of Susumber Berry Toxicity is important for appropriate management of the cases. Cases are managed supportively in monitored setting