Uncommon Millettia pachycarpa Benth poisoning: A case report

Abstract

Background: Millettia pachycarpa Benth, rich in rotenone, can disrupt the mitochondrial electron transport chain. Ingestion may cause respiratory and central nervous system depression, and in severe cases, lead to death. This is the first detailed clinical case report of M. pachycarpa Benth poisoning, aiming to help systematization of diagnosis and treatment. Patient concerns: An elderly male who lost consciousness for 3 hours after consuming the fruit of M. pachycarpa Benth. Arterial blood gas analysis indicated a significant decrease in pH, a sharp increase in lactate levels, and elevated CO2 partial pressure with normal O2 partial pressure. Diagnosis: The patient was diagnosed with food intoxication by M. pachycarpa Benth, concomitant with aspiration pneumonia and distributive shock. Interventions: The patient was given continuous renal replacement therapy (CRRT) and invasive mechanical ventilation. Outcomes: The patient was successfully discharged after 5 days of hospitalization. Follow-up after 2 weeks showed no significant discomfort. Conclusion: Isolated CO2 retention without hypoxemia, significantly reduced pH, and markedly elevated lactate levels strongly suggest poisoning by M. pachycarpa Benth. CRRT and invasive mechanical ventilation are beneficial for patients. Early implementation of CRRT to remove toxins and early initiation of assisted ventilation to improve respiratory failure are recommended upon suspicion of the disease.