title: Gloriosa superba poisoning mimicking an acute infection- a case report.
abstract: BACKGROUND
  Gloriosa superba (GSb) is a highly poisonous plant and its toxicity is due to anti-mitotic effects of constituents such as colchicine and gloriosine on rapidly proliferating cells. Poisoning is known to cause very rapid and severe clinical manifestations due gastro intestinal, neurological, cardiac and bone marrow toxicity.
  
  
  METHODS
  A young male presented with an acute onset febrile illness associated with diarrhoea, confusion, haematuria and aggressive behavior of 4 days duration. He developed subconjunctival haemorrhages, bleeding gums, neck stiffness, bilateral papilloedema, tender hepatomegaly and features suggestive of subacute intestinal obstruction. He had progressive reduction in white cell counts, platelets and derrangements in liver functions. The illness mimicked acute severe leptospirosis or dengue. On day 9 of illness he started to loose his hair and was totally alopecic by day 14. At this stage of illness, possibility of GSb poisoning was suspected. He admitted the act of self harm after repeated questioning.
  
  
  CONCLUSIONS
  His presentation mimicked an acute severe tropical febrile illness such as leptospirosis or dengue until he started to loose his hair. Therefore we feel that Clinicians practicing in tropical setting where Gloriosa superba is endemic should be aware of its clinical presentations and should always consider the possibility of ingestion of Gloriosa superba when the patient has pancytopenia and develops shedding of hairs which results in total alopecia in a case of unexplained gastroenterocolitis, rather investigating.
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. ranjanp64@gmail.com.
authors.forename: Ranjan
authors.initials: R
authors.lastname: Premaratna
authors.affiliation: University Medical Unit, Teaching Hospital Ragama, Ragama, Sri Lanka. mindu123@yahoo.com.
authors.forename: Mindu S
authors.initials: MS
authors.lastname: Weerasinghe
authors.affiliation: University Medical Unit, Teaching Hospital Ragama, Ragama, Sri Lanka. npremawardana@yahoo.com.
authors.forename: Nuwan P
authors.initials: NP
authors.lastname: Premawardana
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. hjanakadesilva@gmail.com.
authors.forename: H Janaka
authors.initials: HJ
authors.lastname: de Silva
mesh_terms: D000208:Acute Disease; D000328:Adult; D003078:Colchicine / Q000506:poisoning; D003715:Dengue / Q000139:chemically induced / Q000175:diagnosis; D003937:Diagnosis, Differential; D005334:Fever / Q000139:chemically induced / Q000175:diagnosis; D006801:Humans; D007239:Infections / Q000175:diagnosis* / Q000209:etiology; D007922:Leptospirosis / Q000139:chemically induced / Q000175:diagnosis; D019668:Liliaceae / Q000737:chemistry*; D008297:Male; D028321:Plant Preparations / Q000506:poisoning*; D011041:Poisoning / Q000150:complications / Q000175:diagnosis*
chemical_list: D028321:Plant Preparations; D003078:Colchicine