Starfruit neurotoxicity mimicking an acute brainstem stroke

Aléssio-Alves, Frederico Fernandes; Souza, Carolina Pinto; Silva, Lucyana Karla da; Moysés-Neto, Miguel; Pontes-Neto, Octávio Marques

doi:10.1016/j.clineuro.2011.10.045

Cited by 3 publications

(2 citation statements)

References 5 publications

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“…One died ½ 1–2 star fruits 2011 Su YJ [ 29 ] Taiwan 1 Normal – Acute oxalate nephropathy Supportive care. Recovered to serum creatinine 0.92 mg/dl 0/1 1 l pure juice 2012 Alessio-Alves et Al [ 30 ] Brazil 1 On HD + N/A HD. Recovered 0/1 Star fruit 2014 Scaranello et al [ 8 ] Brazil 1 Normal – N/A HD.…”

Section: Discussionmentioning

confidence: 99%

Star fruit nephrotoxicity: a case series and literature review

et al. 2018

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BackgroundStar fruit is a popular medicinal fruit in the tropics. Its hypoglycaemic properties are considered useful in achieving glycaemic control in diabetes. Star fruit induced nephrotoxicity is a rare cause of acute kidney injury in individuals with both normal and reduced baseline renal function. We present three cases of acute kidney injury due to star fruit nephrotoxicity from Sri Lanka, and discuss the published literature on this topic.Case presentationThree Sri Lankan patients, all with a background of diabetes, presented to us with acute nausea and anorexia following recent consumption of star fruit. Two patients complained of diarrhoea and one patient complained of intractable hiccoughs. They all had elevated serum creatinine on admission. Two were known to have normal baseline serum creatinine levels. On renal biopsy two had evidence of oxalate crystal deposition. One did not show crystal deposition but had acute interstitial nephritis for which no alternate cause could be identified. Two were treated with short courses of prednisolone and two required acute haemodialysis. All recovered renal function, with both patients with known baselines approaching their premorbid serum creatinine levels.ConclusionConsumption of star fruit, especially on an empty stomach or in a state of dehydration may precipitate acute kidney injury. A history of star fruit ingestion must be actively looked for in patients presenting with unexplained acute kidney injury. The use of star fruit as a therapy for diabetes should be discouraged.

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Section: Discussionmentioning

confidence: 99%

Star fruit nephrotoxicity: a case series and literature review

et al. 2018

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“…Seizure occurs in up to 30% of all cases of intoxication following star fruit ingestion, and the mortality is higher among patients who experience this symptom [ 14 ]. Although most patients improve with hemodialysis, some patients have a more fulminant course and die, regardless of the therapy received [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Neurotoxicity following the Ingestion of Bilimbi Fruit (Averrhoa bilimbi) in an End-Stage Renal Disease Patient on Hemodialysis

Caetano¹,

Sá²,

Faleiros³

et al. 2017

Case Rep Nephrol Dial

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Introduction: The toxic effects of the ingestion of star fruit (Averrhoa carambola) 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, Averrhoa bilimbi species, and exhibits similar biochemical characteristics to star fruit. Objective: To report the case of a patient with chronic kidney disease who developed a seizure disorder after the ingestion of bilimbi fruit. Case Report: 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. Conclusions: 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.

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Association of renal function and symptoms with mortality in star fruit (Averrhoa carambola) intoxication

Chua

Sun

Tsui

et al. 2017

Clinical Toxicology

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Patients with impaired renal function were at higher risks of SF intoxication. Severe neurologic symptoms mandate immediate medical intervention because of the association between their occurrence and high mortalities. Toxin removal through dialysis, rather than symptomatic relief, seems to be beneficial to patient survival. Early and continuous dialysis appears to alleviate severe symptoms and prevent symptom rebounds.

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Starfruit neurotoxicity mimicking an acute brainstem stroke

Cited by 3 publications

References 5 publications

Star fruit nephrotoxicity: a case series and literature review

Star fruit nephrotoxicity: a case series and literature review

Neurotoxicity following the Ingestion of Bilimbi Fruit (Averrhoa bilimbi) in an End-Stage Renal Disease Patient on Hemodialysis

Association of renal function and symptoms with mortality in star fruit (Averrhoa carambola) intoxication

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