title: Star fruit intoxication in a patient with moderate renal insufficiency presents as a posterior reversible encephalopathy syndrome.
abstract: OBJECTIVE
  Star fruit has been reported to contain neurotoxins that often cause severe neurological complications in patients with uremia or severe chronic renal insufficiency. However, the occurrence of neurotoxicity in patients with mild or moderate renal insufficiency has rarely been mentioned.
  
  
  METHODS
  A 67-year-old woman who had diabetes mellitus and moderate renal insufficiency presented with acute onset of hiccups and nausea two hours after ingestion of one fresh star fruit. She further presented with progressively incoherent speech, echolalia and bizarre behavior. On the next day, her consciousness level declined to deep coma and she experienced two seizures. Brain magnetic resonance imaging examinations revealed a focal cerebral lesion over the left occipital area. The clinical symptoms recovered and the brain lesion reversed after emergency hemodialysis.
  
  
  CONCLUSIONS
  The clinicians should be aware that star fruit intoxication must be considered when patients with a chronic renal disease, even mild or moderate chronic renal insufficiency, present with unexplained neurological or psychiatric symptoms. Emergency hemodialysis or other replacement therapies may be required for the management of acute star fruit intoxication.
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan.
authors.forename: Shang-Hang
authors.initials: SH
authors.lastname: Chen
authors.forename: Meng-Hang
authors.initials: MH
authors.lastname: Tsai
authors.forename: Yu-Lung
authors.initials: YL
authors.lastname: Tseng
authors.forename: Yu-Lung
authors.initials: YL
authors.lastname: Tseng
authors.forename: Chun-Chung
authors.initials: CC
authors.lastname: Lui
authors.forename: Yao-Chung
authors.initials: YC
authors.lastname: Chuang
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D004569:Electroencephalography / Q000379:methods; D005260:Female; D005638:Fruit / Q000009:adverse effects*; D006801:Humans; D020258:Neurotoxicity Syndromes / Q000503:physiopathology*; D051437:Renal Insufficiency / Q000209:etiology* / Q000473:pathology