title: In the kingdom of "tortelli" (ravioli-like pasta) plant poisoning is still a threat. A case report of near-fatal poisoning from Digitalis Purpurea accidentally confused with Borago Officinalis.
abstract: A 58 years healthy old woman was admitted to the Emergency Department (ED) with cardiac arrest due to ventricular fibrillation (VF). Appropriate cardiopulmonary resuscitation (CPR), multiple DC shocks and oro-tracheal intubation (OTI) were effective to induce recovery of spontaneous circulation (ROSC). After ROSC was achieved, the electrocardiogram (ECG) showed an idio-ventricular rhythm with atrioventricular dissociation. A transcutaneous pacing was hence applied and the patient was administered with isoproterenol. Simultaneously, her husband was evaluated in the ED for gastrointestinal symptoms occurred after assumption of home-made "tortelli" (ravioli-like pasta) stuffed with cheese and leaves of a plant which they supposed to be borage two days before admission. Borage, during the non-flowering seasons, can be easily confused with foxglove (Digitalis spp.), and this was the main clue to suspect poisoning. Both patients were given DigiFab®, a sheep antibody fragment with high affinity for digoxin. The woman was then admitted in intensive care unit (ICU), where a rapid clinical  improvement occurred, thus allowing discharge in a few days. The husband was instead discharged from the ED after clinical observation and ECG monitoring. In both cases, a significant plasma concentration of digoxin could be measured.
authors.affiliation: University Hospital of Parma, Italy. labonfanti@ao.pr.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Bonfanti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lippi
authors.forename: Irene
authors.initials: I
authors.lastname: Ciullo
authors.forename: Fiorenza
authors.initials: F
authors.lastname: Robuschi
authors.forename: Rosalia
authors.initials: R
authors.lastname: Aloe
authors.forename: Sara
authors.initials: S
authors.lastname: Tarasconi
authors.forename: Riccardo
authors.initials: R
authors.lastname: Vassallo
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Cervellin
mesh_terms: D000368:Aged; D029683:Borago; D004070:Digitalis; D004562:Electrocardiography; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010939:Plant Poisoning / Q000175:diagnosis / Q000209:etiology*; D012720:Severity of Illness Index
keywords: Borago Officinalis; Digitalis Purpurea; cardiac glycosides; digoxin; poisoning; toxicity