Tran Christina Q, Houston Rebecca, Marino Maxwell A, Schiraldi Michael, Miulli Dan E
Neurological Surgery, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, USA.
Neurosurgery, Desert Regional Medical Center, Palm Springs, USA.
Cureus. 2025 May 12;17(5):e83963. doi: 10.7759/cureus.83963. eCollection 2025 May.
The South American shamanic Kambô ritual involves applying the skin secretions of Phyllomedusa bicolor (giant monkey frog) to superficial burns for purported spiritual and therapeutic benefits. These secretions contain a complex mix of bioactive peptides, such as phyllocaerulein, phyllomedusin, phyllokinin, sauvagine, dermorphins, and deltorphins, that interact with diverse neurotransmitter and hormone receptor systems. Specifically, these peptides engage cholecystokinin (CCK) receptors, neurokinin-1 (NK1) receptors, bradykinin B2 receptors, corticotropin-releasing factor (CRF) receptors, and opioid receptors (μ and δ subtypes), influencing gastrointestinal, cardiovascular, endocrine, and neurologic pathways. While often short-lived, these peptides provoke profound physiological disturbances, including violent emesis, vasodilation, fluid shifts, and antidiuretic hormone (ADH) dysregulation. The combination of these effects with ritualistic overhydration of water can trigger life-threatening hyponatremia, cerebral edema, and ultimately, brain death. We present the first documented case of brain death associated with Kambô toxicity. A 35-year-old female developed headache, emesis, and unilateral fixed and dilated pupil within hours of a Kambô ritual. Imaging demonstrated diffuse cerebral edema and loss of intracranial blood flow. Laboratory workup revealed severe hyponatremia, likely due to excessive water intake, peptide-induced emesis with sodium loss, and suspected SIADH. Despite aggressive medical management, the patient progressed to brain death. Kambô rituals are unregulated and increasingly practiced in Western countries despite a lack of medical oversight. The ritual's unique combination of cutaneous toxin delivery, extreme emesis, and excessive water hydration creates a perfect storm for acute symptomatic hyponatremia and cerebral herniation. Physicians should consider Kambô exposure in patients presenting with acute neurologic decline and dot-like burn patterns. Public awareness, clinician education, and the development of treatment algorithms are critical as the use of this neurotoxic ritual continues to expand.
南美洲萨满教的坎波仪式包括将双色叶泡蛙（巨型猴蛙）的皮肤分泌物涂抹在浅表烧伤处，据称具有精神和治疗益处。这些分泌物含有多种生物活性肽的复杂混合物，如绿蛙肽、叶泡蛙肽、叶蛙激肽、 sauvagine、皮啡肽和强啡肽，它们与多种神经递质和激素受体系统相互作用。具体而言，这些肽与胆囊收缩素（CCK）受体、神经激肽-1（NK1）受体、缓激肽B2受体、促肾上腺皮质激素释放因子（CRF）受体以及阿片受体（μ和δ亚型）结合，影响胃肠道、心血管、内分泌和神经通路。虽然这些肽的作用通常是短暂的，但会引发严重的生理紊乱，包括剧烈呕吐、血管扩张、体液转移和抗利尿激素（ADH）失调。这些影响与仪式中过度饮水相结合，可引发危及生命的低钠血症、脑水肿，最终导致脑死亡。我们报告了首例与坎波毒性相关的脑死亡病例。一名35岁女性在参加坎波仪式数小时内出现头痛、呕吐以及单侧瞳孔固定和散大。影像学检查显示弥漫性脑水肿和颅内血流丧失。实验室检查发现严重低钠血症，可能是由于饮水过多、肽诱导的呕吐导致钠流失以及疑似抗利尿激素分泌异常综合征（SIADH）。尽管进行了积极的医疗管理，患者仍进展为脑死亡。坎波仪式不受监管，尽管缺乏医学监督，但在西方国家越来越流行。这种仪式独特地结合了皮肤毒素传递、极度呕吐和过度饮水，为急性症状性低钠血症和脑疝形成创造了一场完美风暴。对于出现急性神经功能衰退和点状烧伤图案的患者，医生应考虑是否接触过坎波。随着这种神经毒性仪式的使用不断扩大，提高公众意识、对临床医生进行教育以及制定治疗方案至关重要。
