Case Report

“Kanvali Kizhangu” Toxicity – A Curious Case Report

S. Kumaresh*

Consultant General Medicine, Kauvery Hospital, Salem

Case Presentation

A 23-year-old male came to our ER with alleged history of consumption of tubers (8/9 numbers).

On enquiring about the type of tubers consumed, attenders identified the tubers as “Kanvali Kizhangu”. The name did not ring a bell! After enquiring with many persons, we came to know that these tubers are usually cultivated for medicinal purposes. At last we found its botanical name “Gloriousa Superba”

Our patient presented with complaints of vomiting and diarrhea.

Investigations

Hb – 12, TC – 8200, PLT COUNT – 4.5 L on Day 1.

On Day 3 patient’s complete blood count revealed pancytopenia (Hb – 8, TC – 2300, PLT COUNT – 80 K) due to bone marrow suppression.

He had elevated SGOT/SGPT and deranged renal parameters.

Management

Patient was treated with repeated gastric wash and was symptomatically managed. Patient started to improve slowly with blood parameters.

Discussion

Gloriousa superba is the state flower of Tamilnadu! It contains colchicine. Colchicine is usually found in two plant species, Colchicum autumnale and Gloriousa superba.

Colchicine has anti mitotic effect which arrests the cell division in metaphase stage. Therefore, cells with highest turnover are usually affected – the epithelial cells of the gastrointestinal tract and the bone marrow.

Due to the bright flame shaped appearance of the flower (Gloriousa superba) they are called as “Kanvali kizhangu”.

Conclusion

Colchicine toxicity has been reported due to therapeutic misadventure as well as with suicidal and homicidal intentions.

In homicidal instances diagnosis is not possible without a high index of suspicion. Identifying the component of the substance consumed in suicidal/homicidal settings is very important.

Appendix 1

D. Suryaprabha*

Senior Executive-Clinical Research, Kauvery Hospitals, India

*Correspondence: Tel.: +91 98414 86267; email: [email protected]

Pharmacology and Toxicology

Gloriosa superba is a highly poisonous plant and its toxicity is due to anti-mitotic effects of constituents such as colchicine and gloriosine on rapidly proliferating cells. Poisoning is known to cause very rapid and severe clinical manifestations due gastro intestinal, neurological, cardiac and bone marrow toxicity. The tuber is used traditionally for the treatment of joint pains, bruises and sprains, colic, chronic ulcers, haemorrhoids, cancer, impotence, nocturnal seminal emissions and leprosy and also for inducing labour pains and abortion. The active alkaloids that are seen in the plant are Colchicine, Gloriosine, Superbine and Salicylic acid. Colchicine, an alkaloid extract from Gloriosa, is used in many rheumatological and immunological diseases in the therapeutics of modern medicine. Usually the symptoms of colchicine toxicity develop within two to six hours after the ingestion of the tubers, which is characterized by numbness and tingling around the mouth and by burningor rawness of the throat. The commonest clinical presentation of poisoning is severe gastroenteritis with nausea, vomiting, bloody diarrhoea leading to dehydration, hypovolemic shock and acute renal failure. The patients may develop respiratory depression, dyspnoea, shock, hypotension, marked leucopoenia, thrombocytopenia, coagulation disorders, oliguria, haematuria, confusion, seizures, coma and ascending polyneuropathy. Death in the severe poisoning cases occurs due to shock, metabolic derangements or respiratory failure. Alopecia and dermatitis develop about one to two weeks after poisoning.

Dr. S. Kumaresh

Consultant General Medicine

D. Suryaprabha

Senior Executive-Clinical Research

“Kanvali Kizhangu” Toxicity – A Curious Case Report

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