Near-fatal poisoning after ricin injection

Area of Science:

• Toxicology
• Clinical Medicine

Background:

• Ricin, a toxin from castor beans (Ricinus communis), is highly toxic.
• Intentional self-injection of ricin is rare but can lead to severe poisoning.

Observation:

• A 21-year-old man self-injected castor bean extract, leading to refractory shock, systemic inflammatory response syndrome, and multiple organ dysfunction.
• Clinical manifestations included rhabdomyolysis, necrotizing fasciitis, and compartment syndrome, requiring fasciotomy and extensive wound care.
• Ricin A-chain was detected in serum and largely excreted in urine, while ricinine was detected in serum and urine for several days.

Findings:

• The patient received approximately 738 µg of ricin A-chain, resulting in severe systemic toxicity.
• Laboratory findings revealed hypoalbuminemia, proteinuria, thrombocytopenia, leukocytosis, elevated cytokines, troponin, and creatine kinase.
• Successful management involved aggressive fluid resuscitation, vasopressors, broad-spectrum antibiotics, surgical debridement, and skin grafting.

Implications:

• This case highlights the extreme toxicity of ricin and the potential for severe, life-threatening poisoning following intentional injection.
• Aggressive supportive care is crucial for managing ricin poisoning, including hemodynamic support and management of organ dysfunction.
• Early detection of ricin and its metabolites aids in diagnosis and understanding the toxicokinetics and management strategies.