Cassia occidentalis is an annual tropical shrub causing toxicity in cattle. However, human case reports of its poisoning are scarce. We, here, report three young children, residents of Western Uttar Pradesh in North India, who presented with lethargy, jaundice, and altered sensorium after consumption of Cassia seeds. The toxidrome was defined as hepatomyoencephalopathy. The children were resuscitated, managed for acute liver failure, and subsequently discharged without sequel. Although few studies have previously documented this association, this is the first such case series documenting a direct causal relationship of Cassia to hepatomyoencephalopathy syndrome. Public and clinician awareness regarding this syndrome mimicking viral encephalitis has the potential to prevent further outbreaks.
Srivastava A, Peshin SS, Kaleekal T, Gupta SK. An epidemiological study of poisoning cases reported to the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi. Hum Exp Toxicol 2005;24:279-85.
Yadav JP, Arya V, Yadav S, Panghal M, Kumar S, Dhankhar S, et al. Cassia occidentalis L.: A review on its ethnobotany, phytochemical and pharmacological profile. Fitoterapia 2010;81:223-30.
Vashishtha VM, Nayak NC, John TJ, Kumar A. Recurrent annual outbreaks of a hepato-myo-encephalopathy syndrome in children in Western Uttar Pradesh, India. Indian J Med Res 2007;125:523-33.
Vashishtha VM, Kumar A, John TJ, Nayak NC. Cassia occidentalis poisoning causes fatal coma in children in Western Uttar Pradesh. Indian Pediatr 2007;44:522-5.
Kumar A. Cassia poisoning behind mysterious disease in children in Uttarakhand. Indian Pediatr 2008;45:423.
Vashishtha VM, John TJ, Kumar A. Clinical & pathological features of acute toxicity due to Cassia occidentalis in vertebrates. Indian J Med Res 2009;130:23-30.
Panigrahi G, Tiwari S, Ansari KM, Chaturvedi RK, Khanna VK, Chaudhari BP, et al. Association between children death and consumption of Cassia occidentalis seeds: Clinical and experimental investigations. Food Chem Toxicol 2014;67:236-48.
Panigrahi GK, Ch R, Mudiam MK, Vashishtha VM, Raisuddin S, Das M, et al. Activity-guided chemo toxic profiling of Cassia occidentalis (CO) seeds: Detection of toxic compounds in body fluids of CO-exposed patients and experimental rats. Chem Res Toxicol 2015;28:1120-32.
Panwar RS. Disappearance of a deadly disease acute hepatomyoencephalopathy syndrome from Saharanpur. Indian J Med Res 2012;135:131-2.