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Case Reports in Transplantation
Volume 2012, Article ID 739238, 4 pages
http://dx.doi.org/10.1155/2012/739238
Case Report

Fulminant Hepatic Failure Attributed to Ackee Fruit Ingestion in a Patient with Sickle Cell Trait

1Department of Pathology, Mount Sinai School of Medicine, One Gustave L. Levy Place, P.O. Box 1194, New York, NY 10029, USA
2Office of the Chief Medical Examiner, 520 First Avenue, New York, NY 10016, USA
3Department of Surgery, Mount Sinai School of Medicine, One Gustave L. Levy Place, P.O. Box 1194, New York, NY 10029, USA

Received 21 August 2012; Accepted 18 September 2012

Academic Editors: M. G. H. Betjes and F. Keller

Copyright © 2012 Dianne E. Grunes et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report a case of fulminant liver failure resulting in emergent liver transplantation following 3 weeks of nausea, vomiting, and malaise from Jamaican Vomiting Sickness. Jamaican Vomiting Sickness is caused by ingestion of the unripe arils of the Ackee fruit, its seeds and husks. It is characterized by acute gastrointestinal illness and hypoglycemia. In severe cases, central nervous system depression can occur. In previous studies, histologic sections taken from patients with Jamaican Vomiting Sickness have shown hepatotoxicity similar to that seen in Reye syndrome and/or acetaminophen toxicity. We highlight macroscopic and microscopic changes in the liver secondary to hepatoxicity of Ackee fruit versus those caused by a previously unknown sickle cell trait. We discuss the clinical variables and the synergistic hepatotoxic effect of Ackee fruit and ischemic injury from sickled red blood cells, causing massive hepatic necrosis in this patient.