Anticholinergic syndrome due to 'Devil's herb': when risks come from the ancient time

Area of Science:

• Toxicology
• Ethnobotany
• Pharmacology

Background:

• Mandragora autumnalis, a solanaceous plant found in Sicily, contains toxic alkaloids.
• It is frequently misidentified as the edible Borago officinalis, leading to accidental poisoning.
• M. autumnalis contains solanum and tropane alkaloids, causing gastrointestinal and anticholinergic effects.

Observation:

• A 72-year-old female ingested M. autumnalis, mistaking it for B. officinalis.
• The patient presented with symptoms consistent with an anticholinergic syndrome.
• Diagnosis was confirmed by clinical presentation and analysis of gastric lavage contents.

Findings:

• The patient exhibited signs of severe anticholinergic syndrome.
• Analysis of the ingested plant confirmed the presence of M. autumnalis alkaloids.
• Decontamination and symptomatic treatment were crucial for recovery.

Implications:

• Highlights the danger of misidentifying wild edible plants.
• Underscores the importance of accurate plant identification in ethnobotanical practices.
• Emphasizes the effectiveness of supportive care in managing M. autumnalis poisoning.