A case report of a woman who became ill after eating a zucchini has highlighted the importance of obtaining 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 the emergency department for suspected gastrointestinal bleeding. She complained of abrupt, severe abdominal pain lasting 10 hours, accompanied by vomiting and bloody, watery diarrhea. She denied consuming any 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 pink.
She was admitted to the intensive care unit with a diagnosis of acute gastroenteritis with dehydration, probably of infectious origin. After treatment, blood pressure normalized, but severe abdominal pain persisted, along with pink watery diarrhea.
Bitter zucchini clue
According to the report, published in the Polish Archives of Internal Medicinephysicians were surprised by the sudden onset of hemorrhagic diarrhea, accompanied by unusually severe abdominal pain and liver damage, in an otherwise healthy individual with a negative epidemiological and drug history.
After re-taking the patient’s medical history, doctors discovered that she had not consumed anything unusual, except fried zucchini with bread, and that she had not taken any medications. The nurse caring for the patient suggested that the problem could be related to the zucchini. After spending more time with the woman, she discovered 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 sources, the diagnosis of cucurbitacin poisoning was proposed. The Czech Toxicological Information Center in Prague confirmed the suspicion. Infectious diarrhea was ruled out the next day. The third day after admission the patient was virtually free of complaints.
Together with the Institute of Forensic Medicine and Toxicology in Prague, scientists planned to confirm the presence of cucurbitacin in the blood using gas chromatography. Unfortunately, the sample could not be found because 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 stresses, such as poor growing conditions, and the levels of these compounds decrease during ripening.
In a French study of 353 people between 2012 and 2016, 95 percent of patients experienced mild poisoning. Symptoms usually appear within minutes to hours after ingestion and usually involve gastrointestinal complaints, such as nausea, vomiting, abdominal cramps and diarrhea.
“The diagnosis is mainly based on the clinical presentation, with an emphasis on a careful history. Physicians should consider the toxicity of cucurbitacin in patients who exhibit symptoms shortly after ingesting plants from the Cucurbitaceae family. It is important to determine whether the plant tasted unusually bitter. This case shows that a well-taken medical history is crucial in the diagnostic process, especially in unclear situations,” researchers said.
Fatal case
Another study reported a fatal case of food poisoning due to cucurbitacin in a zucchini, also known as zucchini.
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, previously healthy couple. Both patients ate a maximum of two bites of a dish with zucchini from their own garden. Two hours after ingestion, the woman contacted the GP post (GPS) with complaints such as nausea, vomiting and diarrhea, which were more serious in the man. She also mentioned a disgusting bitter taste.
The couple was told to maintain fluid balance and contact GPS if symptoms worsened. The next day the woman had recovered, but her husband was still suffering from serious gastrointestinal complaints. A home visit was planned, but by the time the GP visited the patient, he had died of exhaustion and dehydration less than 24 hours after eating the casserole.
The leftover material from the casserole and the zucchini from the vegetable garden were analyzed. The casserole and the own garden zucchini contain cucurbitacin-E, cucurbitacin-E-glucoside and cucurbitacin-I-glucoside, unlike control zucchini from another vegetable garden.
“We present this case to alert doctors to this rare but potentially fatal cause of food poisoning. The medical terminology of food poisoning leads to a diagnosis of bacterial gastroenteritis, which is inadequate in the case of poisoned food,” scientists said.
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