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Case Reports
. 2016 Jan 16;87(3):353-357.

In the kingdom of "tortelli" (ravioli-like pasta) plant poisoning is still a threat. A case report of near-fatal poisoning from Digitalis Purpurea accidentally confused with Borago Officinalis

Laura Bonfanti  1 , Giuseppe Lippi, Irene Ciullo, Fiorenza Robuschi, Rosalia Aloe, Sara Tarasconi, Riccardo Vassallo, Gianfranco Cervellin
Affiliations
Case Reports

In the kingdom of "tortelli" (ravioli-like pasta) plant poisoning is still a threat. A case report of near-fatal poisoning from Digitalis Purpurea accidentally confused with Borago Officinalis

Laura Bonfanti et al. Acta Biomed. .

Abstract

A 58 years healthy old woman was admitted to the Emergency Department (ED) with cardiac arrest due to ventricular fibrillation (VF). Appropriate cardiopulmonary resuscitation (CPR), multiple DC shocks and oro-tracheal intubation (OTI) were effective to induce recovery of spontaneous circulation (ROSC). After ROSC was achieved, the electrocardiogram (ECG) showed an idio-ventricular rhythm with atrioventricular dissociation. A transcutaneous pacing was hence applied and the patient was administered with isoproterenol. Simultaneously, her husband was evaluated in the ED for gastrointestinal symptoms occurred after assumption of home-made "tortelli" (ravioli-like pasta) stuffed with cheese and leaves of a plant which they supposed to be borage two days before admission. Borage, during the non-flowering seasons, can be easily confused with foxglove (Digitalis spp.), and this was the main clue to suspect poisoning. Both patients were given DigiFab®, a sheep antibody fragment with high affinity for digoxin. The woman was then admitted in intensive care unit (ICU), where a rapid clinical improvement occurred, thus allowing discharge in a few days. The husband was instead discharged from the ED after clinical observation and ECG monitoring. In both cases, a significant plasma concentration of digoxin could be measured.

Keywords: Borago Officinalis; Digitalis Purpurea; cardiac glycosides; digoxin; poisoning; toxicity.

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Figures

Figure 1.
Figure 1.
Electrocardiogram recorded few minutes after ROSC
Figure 2.
Figure 2.
Electrocardiogram of the husband of the patient
Figure 3.
Figure 3.
Borago Officinalis: with flowers (left), and leaves only (right)
Figure 4.
Figure 4.
Digitalis Purpurea: with flowers (left), and leaves only (right)
See this image and copyright information in PMC

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