Acute demyelinating encephalitis due to Abrus precatorius poisoning--complete recovery after steroid therapy.
BACKGROUND
Poisoning from Abrus precatorius is attributed to a toxalbumin (abrin) that acts by inhibiting protein synthesis and rarely can cause immuno-mediated demyelination. We report a case of abrin poisoning with demyelination.


METHODS
A 19-year-old man presented with a history of ingesting crushed Abrus precatorius seeds following a family quarrel. He developed vomiting, abdominal pain, and bloody diarrhea, followed by a seizure and an altered sensorium. Magnetic resonance imaging (MRI) of the brain showed demyelination in the bilateral-medial temporal lobes. The patient was treated with supportive care, and intravenous methylprednisolone followed by oral prednisone, and recovered fully.


CONCLUSIONS
Abrin is an immuno-modulator that may cause immune-mediated demyelination. We report the clinical course of a patient with demyelination after abrin poisoning, treated with corticosteroids, and document his clinical recovery.


CONCLUSIONS
Demyelination is a rare complication of Abrus precatorius poisoning. In our case, the demyelination was demonstrated by MRI. Although our patient appeared to recover completely following methylprednisolone therapy, the suggestion that methylprednisolone or other corticosteroids might be useful in treating this demyelination needs experimental verification and clinical validation before concluding that it is a beneficial therapy.
Sahoo
Ratnakar
R
Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India. drksahoo@gmail.com
Hamide
Abdoul
A
Amalnath
S Deepak
SD
Narayana
B Srikant
BS