Abstract
We report a case of ginkgo seed poisoning after eating more than 50 ginkgo-nuts. The patient was a 62-year-old woman who had contact dermatitis caused by ginkgo fruit. She had been eating 5-10 ginkgo-nuts every day for 40 years. She had had lung cancer for 20 months. Temporary remission was achieved by chemotherapy, but bone and brain metastases appeared 10 months ago. She had been taking gefitinib for 9 months. She developed erythema with itching of the lower legs and facial edema a week after peeling ginkgo fruit in October 2004. The eruptions were improved by oral and topical steroid treatment. On October 11, she developed facial edema, transient unconsciousness and sensory aphasia several hours after eating more than 50 ginkgo-nuts. Physical examination on admission revealed no abnormality. Encephalitis or brain metastasis of lung cancer was excluded by brain CT, MRI, EEG and lumbar puncture. We suspected ginkgo seed poisoning. Her sensory aphasia improved gradually after administration of vitamin B6, and she was discharged 2 weeks later. Open patch testing (PT) with ginkgo fruit revealed a positive reaction after 48 hours, and the positive reaction continued for 3 weeks. Closed PT with urushiol and ginkgo leaf revealed positive results. Her first eruption was diagnosed as allergic contact dermatitis caused by ginkgo fruit. Ginkgo seeds are popular food items in Japan, Korea and China. Ginkgo seed poisoning usually occurs in children, who exhibit repetitive seizures that can be fatal. Prompt administration of pyridoxal is effective because this poisoning is caused by 4 methoxypyridoxine contained in ginkgo seed. Early detection and treatment of this ginkgo seed poisoning case was possible due to the preceding contact dermatitis caused by ginkgo fruit.
