Corneal injury by wild taro

Antiproliferative piperidine alkaloids from the leaves of Alocasia macrorrhiza

Seventeen piperidine alkaloids, including 15 previously undescribed 2-substituted-6-(9-phenylnonyl)-piperidine-3,4-diol alkaloids and a previously undescribed 2-substituted-6-(9-phenylnonyl)-piperidine-3-ol alkaloid, were isolated from the leaves of Alocasia macrorrhiza (L.) Schott. Their planar structures and configurations were elucidated based on HR-ESI-MS, 1D and 2D NMR, Snatzke's method, modified Mosher method, single-crystal X-ray crystallography, as well as quantum chemical calculation. It was found that ΔδH5b-H5a can be used to elucidate the relative configuration of 2,3,4,6-tetrasubstituted piperidine, by analyzing the NMR data of 2-substituted-6-(9-phenylnonyl)-piperidine-3,4-diol. Antiproliferative activity was evaluated for all of the alkaloids, and compounds 6-8 showed considerable inhibitory activity against K562 cell line, with the IC50 values of 17.24 ± 1.62, 19.31 ± 0.9 and 18.77 ± 1.09μM, respectively. Furthermore, compounds 6 and 7 exerted an antiproliferative effect by inducing apoptosis.

Epipremnum aureum Keratopathy: Case Report and Review of the Literature

OBJECTIVES

To report a novel case of Epipremnum aureum toxicity masquerading as bilateral infectious keratitis and review the literature on ocular manifestations of Epipremnum exposure.

METHODS

Case report and literature review.

RESULTS

A 70-year-old man with a history of photorefractive keratectomy presented with a 3-day history of bilateral eye pain. The patient reported exposure to plant debris while performing yard work and also water exposure while cleaning his coral fish tanks. Clinical examination revealed bilateral epitheliopathy progressing to frank epithelial defects with underlying stromal necrosis 6 days after exposure. Empiric topical antibiotic drops were initiated, but multiple cultures, corneal biopsy, and confocal microscopy were all negative for an infectious agent. Over a 2-week period, the epithelial defects worsened and a suspicion for a toxic etiology was raised. The patient later recalled rubbing his eyes after exposure to Epipremnum aureum (Golden Pothos/Devils Ivy) sap. He was thus treated conservatively with artificial tears, topical corticosteroids, and amniotic membrane. After 3 months, the epithelial defects resolved, but with corneal scarring, prominently in the left eye and underwent penetrating keratoplasty. Five years after presentation, best-corrected visual acuity with hard contact lenses was 20/25 in the right eye and 20/20 in the left eye.

CONCLUSION

Epipremnum aureum toxicity is a rare cause of keratitis. It can mimic acanthamoeba keratitis or anesthetic abuse and should be considered in cases of culture negative nonhealing corneal ulcerations. Eliciting a history of plant sap exposure can facilitate appropriate supportive care for this toxic keratitis.

Oral Mucosal Irritating Plant Ingestion in Hong Kong: Epidemiology and Its Clinical Presentation

Objective

To study the local epidemiology and clinical presentation after ingestion of oral mucosal irritating plants.

Methodology

Cases presenting with immediate oral mucosal irritation after plant product ingestion from July 2005 to June 2009 were retrieved from the Hong Kong Poison Information Centre's clinical database. Their clinical features and management were reviewed.

Results

Thirty cases were retrieved and analysed, including 14 males and 16 females. Poisoning occurred all year round with no seasonal predilection. Vomiting and dysphagia were the two most common symptoms other than immediate oral mucosal irritation. Half of the cases could be managed with symptomatic treatment and discharged after a few hours of observation. Six patients presented with angioedema and were managed initially with the use of intravenous steroid, antihistamine and with or without adrenaline. Urgent airway assessment with laryngoscope was performed in 3 patients. No patient required endotracheal intubation.

Conclusion

Oral mucosal irritating plant ingestion is not uncommon in Hong Kong. Its clinical feature can mimic angioedema on presentation. Immediate and localized oral mucosal symptoms after plant product ingestion are the key to diagnosis.

Exposure to Euphorbia lathyris latex resulting in alkaline chemical injury: a case report

Introduction

We report the case of a patient with extreme pain following accidental exposure to the latex of Euphorbia lathyris.

Case presentation

A 76-year-old Caucasian woman attended the ophthalmology department with acute severe bilateral eye pain. This occurred immediately after having pulled a weed out of her garden with her bare hands. She recalled having subsequently rubbed her eyes. The offending plant, was brought into hospital and was identified as the Caper Spurge (Euphorbia lathyris). Her ocular pH was alkaline (pH 9). After copious irrigation, the pH normalised. She was treated with topical steroids, cycloplegics, lubricants and opioid oral analgesia. Three days later, she was symptom-free and her vision had returned to normal.

Conclusion

Exposure to Caper spurge latex is a rare cause of keratoconjunctivitis. It can, however, potentially lead to corneal ulceration, anterior uveitis and rarely blindness. Treatment remains largely empirical. Exposure to the milky latex can result in extreme pain requiring prompt treatment. The use of goggles and gloves is recommended when handling this plant.