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Arum palaestinum poisoning: revenge of the witch

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Abstract

The Arum palaestinum plant is one of the 26 species of the Arum genus of the Araceae family. This plant species is found through the Mediterranean region, Western Asia, and Europe. The leaves and seeds of the plant contain needle-shaped oxalate crystals that can irritate the affected tissue (skin, oral cavity, or GI tract) upon exposure. Up to this date, there is no available literature supporting the epidemiology or the clinical manifestations of poisoning by this plant. We retrospectively reviewed all Arum palaestinum exposures to children younger than 18 years of age reported to the Israel National Poison Information Center during 2017 from the IPIC computerized data system. We extracted demographic data and clinical data from those digital files. We reviewed the files of 53 patients’ files and found slight male predominance (58% vs. 42%), and the age of exposure ranged from 9 month to 15 years. The main site of exposure was at home in most cases (47%) followed by outdoor exposure in 40% of the cases. In 66% of the cases, minor clinical manifestations were reported, mainly erythema and mouth irritation, agitation, and drooling. Asymptomatic patients composed 34% of the cases. In 17% of the cases, patients were recommended to visit an ambulatory facility, and other 15% of the cases were referred to the emergency department. There were no cases of severe poisoning, upper airways compromise, or death.

Conclusion: Poisoning by Arum palaestinum is one of the most common pediatric plant poisoning in Israel. Our study supports with clinical data for the first time that this poisoning is self-limited, confined to the affected mucosa, and most likely does not necessitate any intervention.

What is Known

• A. palaestinum poisoning is one of the most common pediatric plant poisoning in Israel.

• The leaves and seeds of the plant contain needle-shaped oxalates crystals.

What is New

• Pediatric exposure to A. palaestinum usually causes only mild and self-limited poisoning.

• Expectant observation is the preferred management of such exposure.

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Abbreviations

A. italicum :

Arum italicum

A. maculatum :

Arum maculatum

A. palaestinum :

Arum palaestinum

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Author information

Authors and Affiliations

  1. Department of Pediatric Emergency Medicine, Hadassah Medical Center and Hebrew University, Mount Scopus Campus, Jerusalem, Israel

    Aus Maree

  2. Department of Pediatric Emergency Medicine, Hadassah Medical Center and Hebrew University, Ein-Kerem Campus, Jerusalem, Israel

    Saar Hashavya & Itai Gross

  3. Department of Emergency Medicine, Hadassah Medical Center and Hebrew University, Ein-Kerem Campus, Jerusalem, Israel

    Yaakov Asaf

  4. Israel Poison Information Center, Rambam Health Care Campus, The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology|, Haifa, Israel

    Yedidia Bentur

Authors
  1. Aus Maree
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  2. Saar Hashavya
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  3. Itai Gross
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  4. Yaakov Asaf
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  5. Yedidia Bentur
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Contributions

A.M., S.H., and Y.B. conceived of the presented idea. Y.B. got the ethical approval of the institutional review board. A.M. and Y.B. collected the data from the computerized files. A.M carried out the statistical analysis. S.H., I.G., and J.A. aided in interpreting the results. A.M., S.H., and Y.B. worked on the manuscript. All authors discussed the results and commented on the manuscript.

Corresponding author

Correspondence to Aus Maree.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board of Rambam Health Care Campus, and a consent waiver was received (approval number 0061-19-RMB).

Additional information

Communicated by Gregorio Paolo Milani

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Maree, A., Hashavya, S., Gross, I. et al. Arum palaestinum poisoning: revenge of the witch. Eur J Pediatr 179, 1553–1557 (2020). https://doi.org/10.1007/s00431-020-03648-x

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  • DOI: https://doi.org/10.1007/s00431-020-03648-x

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