Ecbalium elaterium (squirting cucumber)--remedy or poison?
BACKGROUND
Ecbalium elaterium is a plant endemic to the Mediterranean basin. Its roots and cucumber-shaped fruit have been used in folk medicine since antiquity. The alleged uses of the fruit juice are as a potent cathartic, analgesic, and antiinflammatory agent. Cucurbitacin B, a triterpene derivative is the active antiinflammatory principal.


METHODS
We present a series of 13 patients who were exposed to the juice of Ecbalium elaterium in its natural form. In 3 patients, exposure was intranasal for the treatment of sinusitis or liver cirrhosis. In 3 other cases, children ingested the fruit unwittingly. In 6 patients, exposure was ocular and, in one, dermal. Within minutes of exposure, the patients exhibited irritation of mucous membranes at various degrees of severity manifested as edema of pharynx, dyspnea, drooling, dysphagia, vomiting, conjunctivitis, corneal edema, and erosion, depending on the route of the exposure. Recovery began within several to 24 hours after administration of oxygen, steroids, antihistamines, and beta-2-agonists. Ocular exposures responded to topical steroid and antibiotic eyedrops within a few days. The toddler with the dermal exposure remained asymptomatic.


CONCLUSIONS
Exposure to the juice of Ecbalium elaterium, mainly in its undiluted form, may cause irritation of mucous membranes, supposedly of inflammatory nature. Patients exposed orally or intranasally should be closely followed for upper airway obstruction. Patients exposed ocularly should have their eyes promptly irrigated to prevent corneal and conjunctival injury.
Raikhlin-Eisenkraft
B
B
Israel Poison Information Center, Rambam Medical Center, Technion.
Bentur
Y
Y
D000293:Adolescent; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000506:poisoning / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003231:Conjunctivitis / Q000139:chemically induced; D015715:Corneal Edema / Q000139:chemically induced; D019662:Cucurbitaceae / Q000506:poisoning* / Q000627:therapeutic use*; D003680:Deglutition Disorders / Q000139:chemically induced; D004417:Dyspnea / Q000139:chemically induced; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy; D008297:Male; D009092:Mucous Membrane / Q000187:drug effects / Q000473:pathology; D008517:Phytotherapy; D010936:Plant Extracts / Q000506:poisoning / Q000627:therapeutic use; D011041:Poisoning / Q000628:therapy; D012189:Retrospective Studies; D012852:Sinusitis / Q000188:drug therapy; D014315:Triterpenes / Q000506:poisoning / Q000627:therapeutic use; D014839:Vomiting / Q000139:chemically induced
D000894:Anti-Inflammatory Agents, Non-Steroidal; D010936:Plant Extracts; D014315:Triterpenes; C041246:cucurbitacin B