Acute anticholinergic syndrome from Atropa belladonna mistaken for blueberries.
OBJECTIVE
To report the first case in the ophthalmic literature of acute anticholinergic syndrome after ingestion of Atropa belladonna mistaken for blueberries.


METHODS
A 36-year-old woman presented to our ophthalmic emergency department with complaints of blurry vision, lightning flashes, disorientation, loss of balance, agitation, and anxiety for 24 hours. Ophthalmic examination revealed bilateral pupillary dilatation and paresis of accommodation. Additional symptoms of the anticholinergic syndrome were elicited on further questioning.


RESULTS
Anticholinergic intoxication was suspected and the patient admitted to have eaten six "blueberries" found in the forest the previous day. The patient identified Atropa belladonna as the source of the berries she had eaten when shown photographs of the plant and its fruit. The recommendations of the Swiss Toxicological Information Centre were followed and physostigmine, the antidote for severe poisoning when 10 or more berries are ingested, was not administered.


CONCLUSIONS
Accidental ingestion of Atropa belladonna berries may cause patients to first consult an ophthalmologist. It is important to recognize the anticholinergic syndrome caused by such intoxication in order to make a proper diagnosis, avoid unnecessary testing, and provide expedient appropriate treatment when required.
Mateo Montoya
A
A
Ophthalmology Clinic, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland.
Mavrakanas
N
N
Schutz
J S
JS
D000208:Acute Disease; D000328:Adult; D001532:Atropa belladonna / Q000506:poisoning*; D001285:Atropine / Q000506:poisoning*; D029798:Blueberry Plants; D003221:Confusion / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005638:Fruit; D006801:Humans; D018727:Muscarinic Antagonists / Q000506:poisoning*; D015878:Mydriasis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D010939:Plant Poisoning / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D004856:Postural Balance; D011680:Pupil; D012678:Sensation Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D013577:Syndrome; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology
D018727:Muscarinic Antagonists; D001285:Atropine