Eating Your Vegetables May Not Always Be Beneficial

CASE REPORT A 50-year-old premorbidly healthy man had consumed 1 glass of bottle gourd juice to help with weight loss. He presented 3 hours later with giddiness and syncope with severe shock with systolic blood pressure of 50 mm Hg. Electrocardiogram showed no significant ST-T changes. He developed hematemesis and profuse hematochezia approximately 6 hours after consumption. The patient was intubated, transfused multiple blood products, and was continued on inotropic support. Upper gastrointestinal tract scopy and sigmoidoscopy revealed extensive necrosis of the gastrointestinal tract with rapid exudation of fluid into the lumen (Figure 1). The patient succumbed to the disease within 24 hours of presentation despite all efforts.Figure 1.: Endoscopic image (A) of gastric body showing extensive necrosis of mucosa and denudation, (B) of gastric fundus showing extensive necrosis of mucosa and denudation with necrotic overlying exudate, (C) of second part of duodenum showing extensive necrosis of mucosa and accumulation of exudated fluid, and (D) of sigmoid colon showing patchy necrosis of mucosa and denudation.Cucurbitaceae produce cucurbitacins to protect the plant from insects. The amount of cucurbitacin produced varies with extremes of temperature, low pH, and other factors. The bitterness of the juice is a result of increased concentrations of these toxins. The toxic effects are dose-dependent with around 300 mL being fatal dose. Cucurbitacins prevent binding of cortisol glucocorticoid receptors in HeLa cells in mice in a dose-dependent manner.1 Cucurbitacin D increases capillary permeability and leads to extensive fluid exudation. A previous case report with bitter bottle gourd consumption has described the stomach, small intestine, and large intestine to be intensely hemorrhagic, reddish in color with velvety feel, mucous mixed with blood present in the lumen on autopsy.2 Learning point—Cucurbitaceae is a wide range of vegetables with various species used in different parts of the world. The consumption of bitter variants of this family can lead to such fatal toxicities. Education about the same of the local population can prevent such mishaps. DISCLOSURES Author contributions: The author participated in data collection, analysis, final drafting, and proofreading of the final manuscript. Financial disclosure: None to report. Previous presentation: This case was presented at ENDOCON 2024; April 19-21, 2024; New Delhi, India. Informed consent was obtained for this case report.