Brugmansia suaveolens (angel’s trumpet) tea poisoning in a previously healthy young patient: a case report

Abstract

INTRODUCTION: Brugmansia suaveolens, popularly known as “angel’s trumpet,” is a plant with anticholinergic alkaloids that inhibit the activity of muscarinic receptors in the central and peripheral nervous system. Its toxicity results in agitation, hallucinations, hyperthermia, tachycardia, rhabdomyolysis, renal failure, and death. OBJECTIVE: Report a case of acute intoxication due to ingestion of “angel’s trumpet” tea, with associated fulminant hepatitis. METHODS: We present a case report with clinical and laboratory data collected from medical records. The study was approved by the Research Ethics Committee, and Written Informed Consent was obtained from a legally responsive relative. CASE REPORT: A healthy 19-year-old male was hospitalized with a fever of 41°C and generalized tonic-clonic seizures, progressing to orotracheal intubation. He exhibited fixed mydriasis and neck stiffness. We were informed by the family that the patient had made use of the tea from the “angel’s trumpet” plant. At admission, he performed a computerized cranial tomography, which showed no midline shift, cerebrospinal fluid without alterations, arterial blood gas analysis with severe metabolic acidosis, acute renal failure requiring dialysis, and fulminant acute liver failure. CONCLUSIONS: “Trumpet tea” intoxication is a neurological emergency that must be quickly recognized for its potential fatal effects. With meningitis as a differential diagnosis, it is important to collect a complete history taking to investigate possible previous contact with the plant. To our knowledge, this is the first case report of fulminant hepatitis caused by “angel’s trumpet,” in addition to the neurological symptoms already described in the literature, which further corroborates the importance of the topic in question.