Fatal plant poisoning cases in Tunisia: a retrospective series

Medicinal plants are widely used and commonly considered safe. However, certain species contain toxic compounds that may cause severe or fatal poisoning. This study aimed to describe fatal cases of plant poisoning reported to the toxicology laboratory of a Tunisian university hospital over a ten-year period. This retrospective study was conducted at the Toxicology Laboratory of Fattouma Bourguiba University Hospital in Monastir, Tunisia, over the period from 2014 to 2023. Data were collected from toxicological analysis reports and laboratory records. Only cases of suspected plant poisoning referred for medico-legal toxicological analysis and resulting in death were included. Data collected related to patient characteristics, plant species involved, circumstances of exposure, and clinical signs observed before death. Five fatal cases of plant poisoning were recorded. Most cases occurred in the context of medicinal use. In one case, the circumstances of exposure were uncertain but were reported to have followed advice from a spiritual healer. Three plant species were implicated: Peganum harmalaL., Ephedra alata Decne. subsp. alenda (Stapf) Trab and Ecballium elaterium (L.) A. Rich. Clinical manifestations ranged from gastrointestinal and neurological symptoms progressing to respiratory arrest, to cardiovascular complications and multiorgan failure, depending on the plant species. Fatal plant poisonings, although rare, highlight the potential toxicity of medicinal plants commonly perceived as safe, mainly due to the presence of toxic bioactive compounds. Increasing awareness among healthcare professionals and the general population is essential to prevent such outcomes.