title: Neurotoxicity following the Ingestion of Bilimbi Fruit (Averrhoa bilimbi) in an End-Stage Renal Disease Patient on Hemodialysis.
abstract: BACKGROUND
  The toxic effects of the ingestion of star fruit(Averrhoa carambola)in chronic kidney disease patients are well described in the literature. Recently, the compound caramboxin has been isolated, explaining the mechanisms of its neurotoxicity. Bilimbi fruit belongs to the family Oxalidaceae,Averrhoa bilimbispecies, and exhibits similar biochemical characteristics to star fruit.
  
  
  OBJECTIVE
  To report the case of a patient with chronic kidney disease who developed a seizure disorder after the ingestion of bilimbi fruit.
  
  
  METHODS
  A 69-year-old man with chronic kidney disease on hemodialysis therapy had intractable hiccups, myoclonus, and generalized tonic-clonic seizures after the consumption of a moderate amount of bilimbi fruit. The electroencephalogram showed a pattern of seizure disorder despite the use of anticonvulsant drugs. Renal replacement therapy was maintained during the whole period and prescribed according to the patient's hemodynamic status. Despite showing clinical resolution of the seizure disorder, the patient died on the 27th day of hospitalization for infectious complications.
  
  
  CONCLUSIONS
  The neurologic status without any other known cause and with clear temporal association with the ingestion of the fruit suggests the diagnosis of neurotoxicity. We propose the hypothesis that the bilimbi fruit has neurotoxic effects similar to those exhibited by the star fruit.
authors.affiliation: Division of Internal Medicine, Urgency Hospital of Goiânia, Goiânia, Brazil.
authors.forename: Camille Pereira
authors.initials: CP
authors.lastname: Caetano
authors.affiliation: Division of Internal Medicine, Urgency Hospital of Goiânia, Goiânia, Brazil.
authors.forename: Cinara Barros
authors.initials: CB
authors.lastname: de Sá
authors.affiliation: Division of Internal Medicine, Urgency Hospital of Goiânia, Goiânia, Brazil.
authors.forename: Bruno Antônio Paixão
authors.initials: BA
authors.lastname: Faleiros
authors.affiliation: Division of Internal Medicine, Urgency Hospital of Goiânia, Goiânia, Brazil.
authors.forename: Marcelo Fonseca Coutinho Fernandes
authors.initials: MF
authors.lastname: Gomes
authors.affiliation: Department of Internal Medicine, Federal University of Goiás, Goiânia, Brazil.
authors.forename: Edna Regina Silva
authors.initials: ER
authors.lastname: Pereira
keywords: Averrhoa; Chronic kidney disease; Epileptic status; Foodborne diseases