Caetano Camille Pereira, de Sá Cinara Barros, Faleiros Bruno Antônio Paixão, Gomes Marcelo Fonseca Coutinho Fernandes, Pereira Edna Regina Silva
Division of Internal Medicine, Urgency Hospital of Goiânia, Goiânia, Brazil.
Department of Internal Medicine, Federal University of Goiás, Goiânia, Brazil.
Case Rep Nephrol Dial. 2017 Jan 20;7(1):6-12. doi: 10.1159/000454945. eCollection 2017 Jan-Apr.
The toxic effects of the ingestion of star fruit in chronic kidney disease patients are well described in the literature. Recently, the compound caramboxin has been isolated, explaining the mechanisms of its neurotoxicity. Bilimbi fruit belongs to the family Oxalidaceae, species, and exhibits similar biochemical characteristics to star fruit.
To report the case of a patient with chronic kidney disease who developed a seizure disorder after the ingestion of bilimbi fruit.
A 69-year-old man with chronic kidney disease on hemodialysis therapy had intractable hiccups, myoclonus, and generalized tonic-clonic seizures after the consumption of a moderate amount of bilimbi fruit. The electroencephalogram showed a pattern of seizure disorder despite the use of anticonvulsant drugs. Renal replacement therapy was maintained during the whole period and prescribed according to the patient's hemodynamic status. Despite showing clinical resolution of the seizure disorder, the patient died on the 27th day of hospitalization for infectious complications.
The neurologic status without any other known cause and with clear temporal association with the ingestion of the fruit suggests the diagnosis of neurotoxicity. We propose the hypothesis that the bilimbi fruit has neurotoxic effects similar to those exhibited by the star fruit.
文献中已充分描述了慢性肾病患者食用杨桃的毒性作用。最近，已分离出化合物香豆素，解释了其神经毒性机制。罗望子果属于酢浆草科，与杨桃具有相似的生化特性。
报告一例慢性肾病患者在食用罗望子果后发生癫痫发作的病例。
一名69岁接受血液透析治疗的慢性肾病男性，在食用适量罗望子果后出现顽固性呃逆、肌阵挛和全身性强直阵挛发作。尽管使用了抗惊厥药物，脑电图仍显示出癫痫发作模式。在整个期间维持肾脏替代治疗，并根据患者的血流动力学状态进行调整。尽管癫痫发作在临床上已得到缓解，但患者在住院第27天因感染并发症死亡。
无其他已知病因且与食用水果有明确时间关联的神经学状态提示神经毒性的诊断。我们提出假说，罗望子果具有与杨桃相似的神经毒性作用。
