Disclosures: Lawrence Andrew L. Chan, DO: No financial relationships or conflicts of interest

Case Diagnosis: Susumber Berry Toxicity

Case Description: 67 and 72 year-old sisters of Afro-Caribbean descent presented to the emergency department with dizziness, dysarthria, dysphagia and difficulty walking. Both were evaluated by the neurology team for suspected ischemic stroke. Initial stroke workup with CT and MRI head were negative, with improvement of symptoms within 24 hours. Laboratory testing was remarkable for elevated transaminases and creatinine kinase (CK) levels. The sisters reported becoming ill after ingestion of “Gully Berries” imported from Jamaica, West Indies.

Setting: Inpatient ConsultationAssessment/

Results: These sisters both shared a traditional meal made with Susumber berries imported from Jamaica approximately 12 hours prior to their presentation in the emergency room. Both sisters developed elevated CK and transaminases, hypertension, and symptoms suggestive of stroke. New York City Poison Control Center was notified. Both patients were maintained on intravenous fluids, cardiac monitoring, pulse oximetry monitoring, and laboratory monitoring. Their symptoms as well as their laboratory abnormalities mostly resolved by the time of discharge from the hospital.

Discussion: Susumber or “Gully berries” are native to Jamaica and are used in traditional Afro-Caribbean cuisine. Native Jamaicans are trained to avoid consumption of immature Susumber berries which can be toxic. Toxicity is considered to be caused by steroid glycoalkaloids that inhibit plasma and erythrocyte acetylcholinesterases and directly stimulate cholinergic receptors. Prior case reports of toxicity have described symptoms frequently found in stroke patients, including dysarthria, dysphagia, dysmetria, blurred vision, and difficulty walking. Transaminitis, hypertension, bradycardia, and rhabdomyolysis are also often seen after ingestion of immature Susumber berries as seen in these two patients, however our patients did not develop severe cholinergic poisoning requiring ventilatory support.

Conclusion: Clinician and patient awareness of possible cholinergic toxicity due to Susumber Berry ingestion should be considered in the Afro-Caribbean population particularly when several people develop symptoms consistent with stroke following ingestion of shared meal.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/berry-poisoning-presenting-with-stroke-like-symptoms-a-case-series/