Fatal Fruit: Unveiling the Risks and Responses to Ackee Poisoning in a South Florida Inpatient Unit

The ackee fruit is a staple in many Afro-Caribbean diets. Yet, when consumed in its unripe form, it can induce Jamaican vomiting sickness, a potentially fatal condition caused by hypoglycin, a toxin that disrupts fatty acid oxidation and gluconeogenesis. Although cases are well-documented in endemic regions, reports outside the Caribbean remain rare. We report the case of a 33-year-old male with no comorbidities who presented in South Florida with acute metabolic encephalopathy, severe hypoglycemia, and profound electrolyte disturbances following the ingestion of unripe ackee fruit. Despite early recognition and aggressive interventions, including glucose administration, supportive therapy, and management coordinated by internal medicine, neurology, nephrology, toxicology, intensive care, and palliative care teams, the patient's clinical condition continued to deteriorate over 21 days post-exposure. This case is distinctive for its occurrence in a non-endemic region, the absence of comorbidities, and the refractory course despite multidisciplinary intervention. It highlights both the diagnostic and therapeutic challenges of ackee poisoning in unfamiliar clinical settings. Increased globalization and the availability of culturally specific foods in diverse regions may increase the likelihood of similar presentations outside endemic areas. Awareness among healthcare providers is therefore essential. Ackee poisoning should be considered in patients presenting with unexplained hypoglycemia and encephalopathy, particularly in communities with Afro-Caribbean dietary practices. Early recognition, timely intervention, and interdisciplinary collaboration remain critical to improving patient outcomes. This case underscores the importance of provider awareness regarding culturally specific dietary exposures and their potential for severe toxicological consequences.