title: Peculiar acute toxic colitis after ingestion of colocynth: a clinicopathological study of three cases.
abstract: We report three examples of toxic acute colitis which occurred after ingestion of colocynth (Citrullus colocynthis) for ritual purposes. The prominent clinical feature was dysenteric diarrhoea; colonoscopic changes included congestion and hyperaemia of the mucosa with abundant exudates but no ulceration or pseudopolyp formation. A causal relationship between colonic injury and the intake of colocynth was supported by the following features: (1) the pharmacology of the colocynth extract ingested; (2) the temporal relationship between colocynth intake and clinical onset (eight to 12 h); (3) the rapid recovery within three to six days, with normal endoscopy at day 14; (4) the absence of other possible causes for the observed patterns, except in one case, in which a concomitant intestinal infection with Clostridium perfringens Type A was discovered; (5) the specific pathological features. Colonic biopsies taken 27, 44, and 72 h after colocynth intake showed: erosions with fibrino-purulent exudate, early fibrosis of the lamina propria, hyaline thickening of the superficial epithelial basal membrane. These pathological features completely disappeared within 14 days in all three cases.
authors.affiliation: Service de Gastroentérologie, Hôpital Victor Jousselin, Dreux, France.
authors.forename: D
authors.initials: D
authors.lastname: Goldfain
authors.forename: A
authors.initials: A
authors.lastname: Lavergne
authors.forename: A
authors.initials: A
authors.lastname: Galian
authors.forename: L
authors.initials: L
authors.lastname: Chauveinc
authors.forename: F
authors.initials: F
authors.lastname: Prudhomme
mesh_terms: D000208:Acute Disease; D000328:Adult; D003092:Colitis / Q000209:etiology* / Q000473:pathology; D005638:Fruit / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged