Bottle gourd (Lagenaria siceraria) toxicity: a "bitter" diagnostic dilemma

Consumption of a glass of bottle gourd juice is thought to work as a health "tonic" and part of traditional healthy living practices in India. The juice may in certain circumstances turn bitter with increased levels of the cytotoxic compound called Cucurbitacins. If the bitter juice is consumed it causes a toxic reaction in the gut, leading to abdominal discomfort/pain, vomiting, hematemesis, and hypotension which may be rarely fatal, especially in persons with pre-existing illness. In the absence of clear cut history regarding the consumption of the bitter bottle gourd juice and the initiation of symptoms, the differential diagnosis for the above symptoms will include diseases causing gastrointestinal bleed with hypotension and/or shock. We report a case of bitter bottle gourd poisoning presenting with abdominal symptoms, hematemesis and shock and with an initial differential diagnosis of septicemia with septic shock and multi-organ involvement. We conduct a literature review and ponder the various differential diagnoses of this clinical scenario.