Distigmine bromide is widely used to treat neurogenic bladder. It may cause cholinergic crisis, a serious side effect. We report the case of an 86-year-old woman with neurogenic bladder who had been taking 5 mg of distigmine bromide orally daily for over a year. She presented to our emergency room unconscious with hypotension and bradycardia. She was intubated, high-dose catecholamine was administered, and a temporary pacemaker was placed. She remained hypotensive. Based on her physical findings, particularly excessive sweating, myosis, and increased salivation, along with low serum cholinesterase, cholinergic crisis due to distigmine bromide was diagnosed. We attempted to resuscitate her with intravenous atropine；however, she died from intestinal necrosis. This case suggests that even a low dose of distigmine bromide can induce a cholinergic crisis. Differential diagnosis is difficult in the early phase of the disease. When examining a patient who is taking distigmine bromide, always considering the possibility of the toxidrome of cholinesterase inhibiters is essential.

Background: The bulbs and tubers of autumn crocus, a member of the Liliaceae family, contain colchicine. Two or three cases of colchicine poisoning due to an accidental ingestion of autumn crocus are reported each year in Japan, and some cases have involved severe illness and even death. We report a case of colchicine poisoning in which the patient recovered after conservative treatment despite her ingestion of a lethal dose of colchicine.

Case: A 61-year-old Japanese woman had prepared stir-fried vegetables and with the other vegetables, she ingested a plant from her garden that had appeared to be lily root. She experienced nausea and vomiting that night. It was later discovered that the plant she had ingested was autumn crocus, and colchicine poisoning was suspected. The amount of colchicine that she had consumed was predicted to be more than lethal. She came to our hospital. We inserted a gastric tube, administered repeated doses of activated charcoal, and followed the patient carefully in the intensive care unit. During the patientʼs course, gastrointestinal symptoms and bone marrow suppression were observed, but all symptoms improved. The patient was discharged home on the 13th day.

Conclusion: We treated a patient with colchicine poisoning due to accidental ingestion of autumn crocus. Although the dose of colchicine ingested was estimated to be higher than a lethal dose, the patient was treated conservatively and showed a good course. We speculate that the cooking method used by the patient may have affected the outcome.

Introduction: Abrus precatorius (commonly known as jequirity bean or rosary pea) is a perennial herb of the subfamily Fabaceae that is native to the southern subtropics. Its seeds contain abrin, which inhibits protein synthesis and induces apoptosis as observed in subjects with poisoning. We describe a case of abrus precatorius poisoning in which an individual ingested this plant in a suicide attempt.

Case: The patient was a Japanese male in his 20s being treated for depression. On the day before his visit, he crushed seeds of approximately 10 grams abrus precatorius which he purchased on a website and took intravenously and orally for an attempted suicide. After the intake, diarrhea and vomiting symptoms appeared. He admitted to our hospital as Abrus precatorius poisoning for further observation. Although he had transient mild acute renal failure the day after admission, he was discharged on his fourth day in the hospital with no prognostic symptoms.

Conclusion: We have experienced the first case of Abrus precatorius poisoning in Japan, and have learned that Abrus precatorius is becoming more readily available. It should be noted that the number of Abrus precatorius poisoning is likely to increase in Japan in the future as in overseas.

Diphenhydramine is a histamine H₁-receptor antagonist that is commonly used for allergic reactions and frequently found in sleep aid products. A female in her 20s was brought to the emergency department with active tonic seizures after an intentional overdose of an over-the-counter drug containing diphenhydramine salicylate. Because the generalized tonic seizure continued for 52 min despite intravenous administration of diazepam, she underwent endotracheal intubation and continuous infusion of sedative agents, which terminated her seizures. Although her refractory status epilepticus was controlled using multiple antiepileptic medications, the state of severely impaired consciousness was prolonged, resulting in a vegetative state. While a literature search suggests that status epilepticus caused by diphenhydramine overdose is uncommon, special attention should be paid to this devastating neurological complication, and prompt medical management should be considered.

Symplocarpus nipponicus Makino, a member of the Araceae family, contains insoluble needle-shaped calcium oxalate crystals that cause oral mucosal injury. We report two cases of a 55-year-old man and an 81-year-old woman who presented to the emergency department after ingestion of Symplocarpus nipponicus Makino that was accidentally identified as Hosta sieboldiana, a wild plant used for edible. Both patients experienced oral pain but recovered and were discharged the following day. Although Symplocarpus nipponicus Makino is unlikely to be ingested in large quantities owing to oral pain associated with its intake, physicians should be aware of its severe mucous membrane irritant effect that necessitates emergency treatment including airway management.