title: Hepatorenal injury induced by cutaneous application of Atractylis gummifera L.
abstract: BACKGROUND
  In Mediterranean countries, intoxication by Atractylis gummifera L. is frequent and characterized principally by hepatorenal injury, often fatal. Its toxicity after a cutaneous application is unknown. We report a case of poisoning by A. gummifera L. induced by repeated cutaneous application.
  
  
  METHODS
  A 30-month-old boy was admitted in our pediatric intensive care unit in coma (Glasgow Coma Scale 8). Investigations showed hepatic cellular injury, cholestasis, decreased prothrombin level, and increased creatinine. History from the parents revealed repeated and occlusive cutaneous application of A. gummifera L. on a skin burn. Qualitative analysis of urine confirmed the diagnosis of A. gummifera poisoning. The child was discharged after 16 days of hospitalization with residual renal insufficiency.
  
  
  CONCLUSIONS
  Poisoning by A. gummifera L. after cutaneous application has not previously been reported in the literature. The prevention of this poisoning, particularly frequent in Mediterranean countries, is mainly based on the education of the public concerning the dangers of this plant.
authors.affiliation: Pediatric Intensive Care Unit, Children's Hospital of Tunis, Tunis, Tunisia. asma.bouziri@yahoo.fr
authors.forename: Asma
authors.initials: A
authors.lastname: Bouziri
authors.forename: Asma
authors.initials: A
authors.lastname: Hamdi
authors.forename: Khaled
authors.initials: K
authors.lastname: Menif
authors.forename: Nejla
authors.initials: N
authors.lastname: Ben Jaballah
mesh_terms: D036083:Atractylis / Q000506:poisoning*; D001278:Atractyloside / Q000506:poisoning; D002675:Child, Preschool; D006801:Humans; D008099:Liver / Q000187:drug effects*; D008297:Male; D010939:Plant Poisoning / Q000175:diagnosis / Q000209:etiology*; D051437:Renal Insufficiency / Q000139:chemically induced*
chemical_list: D001278:Atractyloside