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VOLUME 24 , ISSUE 7 ( July, 2020 ) > List of Articles

CASE REPORT

The First Case Series Report of Typhonium trilobatum Tuber Poisoning in Humans

Devendiran Anandhi, K. N. J. Prakash Raju, Vivekanandan Muthu Pillai, Vadivelu Kumaresan

Keywords : Angioedema, Karunai-k-kilanku, Typhonium trilobatum, Wild tuber

Citation Information : Anandhi D, Raju KN, Pillai VM, Kumaresan V. The First Case Series Report of Typhonium trilobatum Tuber Poisoning in Humans. Indian J Crit Care Med 2020; 24 (7):581-584.

DOI: 10.5005/jp-journals-10071-23479

License: CC BY-NC 4.0

Published Online: 05-09-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Typhonium is a genus belonging to the Araceae family, native to southern Asia and Australia. In folk medicine, Typhonium is used for its analgesic, anti-inflammatory, antidiarrheal, and wound-healing properties. We report a toxidrome of airway compromise due to Typhonium trilobatum tuber ingestion. We present an interesting case series of four patients who consumed raw tuber of T. trilobatum with suicidal thoughts. They exhibited a constellation of symptoms such as swelling of lips and tongue, drooling of saliva, and severe throat pain. One patient had significant upper airway edema and severe respiratory distress requiring emergency endotracheal intubation. Laboratory investigations were grossly normal in all four individuals, expect for mild asymptomatic hypokalemia in one and eosinophilia in another patient. We successfully managed all our patients with repeated adrenaline nebulization, antihistamines, and steroids. Typhonium is believed to be a beneficial herb. Toxicity of Typhonium is not reported much in the literature till date. An emergency department (ED) physician should be aware of this tuber toxicity as it presents with airway compromise, which resolves over hours. The symptoms are due to the local effects of calcium oxalate crystals in the tuber. Airway management is the priority and repeated adrenaline nebulization together with supportive care is advised.


  1. Eddleston M. Patterns and problems of deliberate self-poisoning in the developing world. Q J Med 2000;93(11):715–731. DOI: 10.1093/qjmed/93.11.715.
  2. Ghani A. Medicinal plants of Bangladesh: chemical constituents and uses. 2nd ed., Dhaka, Bangladesh: J Asiat Soc Bangladesh; 2003. pp. 31. 39-40, 418, 500-5, 580-9.
  3. Ali K, Ashraf A, Biswas NN. Analgesic, anti- inflammatory and anti-diarrheal activities of ethanolic leaf extract of Typhonium trilobatum L. Schott. Asian Pac J Trop Biomed 2012;2(9):722–729. DOI: 10.1016/S2221-1691(12)60217-2.
  4. Roy SK, Mishra PK, Nandy S, Datta R, Chakraborty B. Potential wound healing activity of the different extract of Typhonium trilobatum in albino rats. Asian Pac J Trop Biomed 2012(3):S1477–S1486. DOI: 10.1016/S2221-1691(12)60441-9.
  5. Mohan S, Abdul AB, Wahab SIA, Al-Zubairi AS. Antibacterial and antioxidant activities of Typhonium flagelliforme (Lodd) Blume tuber. Am J Biochem Biotechnol 2008;4(4):402–407. DOI: 10.3844/ajbbsp.2008.402.407.
  6. Alfarabi M, Rosmalawati S, Bintang M, Miftahudin, Rofa'ani E, Chaidir. Antiproliferation activity of tuber protein from Typhonium flagelliforme (Lord.) blumei on MCF-7 cell line. Int J Biosci 2015;6(12):52–60. DOI: 10.12692/ijb/6.12.52-60.
  7. Farida YP, Wahyudi S, Wahono S, Hanafi M. Flavonoid glycoside from the ethyl acetate extract of keladitikus Typhonium flagelliforme (Lodd) Blume leaves. Asian J Nat Appl Sci 2012;4: 16–21.
  8. Hegnauer R, Araceae. Review of cyanogenesis and cyanogenic compounds. 1986; pp 581-591.
  9. Franceschi VR, Nakata PA. Calcium oxalate in plants: Formation and function. Annu Rev Plant Biol 2005;56(1):41–71. DOI: 10.1146/annurev.arplant.56.032604.144106.
  10. Slaughter RJ, Beasley DM, Lambie BS, Wilkins GT, Schep LJ. Poisonous plants in New Zealand: a review of those that are most commonly enquired about to the national poisons centre. N Z Med J 2012;125(1367):87–118.
  11. Mrvos R, Dean BS, Krenzelok EP. Philodendron/Dieffenbachia ingestions – are they a problem. J Toxicol Clin Toxicol 1991;29(4):485–491. DOI: 10.3109/15563659109025745.
  12. Gardner DG. Injury to the oral mucous-membranes caused by the common houseplant, dieffenbachia – a review. Oral Surg Oral Med Oral Pathol 1994;78(5):631–633. DOI: 10.1016/0030-4220(94) 90177-5.
  13. Chen CL, Fang HC, Chou KJ, Wang JS, Chung HM. Acute oxalate nephropathy after ingestion of star fruit. Am J Kidney Dis 2001;37(2):418–422. DOI: 10.1053/ajkd.2001.21333.
  14. Šnajdauf J, Mixa V, Rygl M, Vyhnánek M, Morávek J, Kabelka Z. Aortoesophageal fistula – an unusual complication of esophagitis caused by dieffenbachia ingestion. J Pediatr Surg 2005;40(6):e29–e31. DOI: 10.1016/j.jpedsurg.2005.03.036.
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