| Disease | 1 27-YEAR OLD JAMAICAN MALE PRESENTED WITH A 2-MONTH HISTORY OF JAUNDICE, PRURITUS, INTERMITTENT DIARRHEA, AND RIGHT UPPER QUADRANT ABDOMINAL PAIN. OVER THE NEXT MONTH, HIS ABDOMINAL PAIN AND DIARRHEA IMPROVED, BUT HIS JAUNDICE AND PRURITUS
WORSENED. HE WAS AFEBRILE AND PROFOUNDLY JAUNDICED, WITH A BENIGN ABDOMINAL EXAMINATION. MEDICAL WORKUP INCLUDED A NORMAL ABDOMINAL ULTRASOUND, IRON STUDIES, CERULOPLASM, AND SERUM ELECTROPHORESIS. NEGATIVE VIRAL (EPSTEIN-BARR VIRUS,
CYTOMEGALOVIRUS, MOMONUCLEOSIS, HEPATITIS A, B, C) STUDIES, ANA, AMA, ASMA, RPR WERE NOTED. HE DENIED ANY ALCOHOL, DRUG, OR TOXIN EXPOSURE. LIVER TESTS REVEALED TOTAL BILIRUBIN OF 25.6 MG/DL, DIRECT BILIRUBIN OF 13.9 MG/DL, ALKALINE PHOSPHATASE
278 IU/L, AST 45IU/I., AND ALT 71 IU/L. LIVER BIOPSY DEMONSTRATED CENTRILOBULAR ZONAL NECROSIS AND CHOLESTASIS MOST CONSISTENT WITH A TOXIC REACTION. THE PATIENT WAS AGAIN INTERIVEWED REGARDING POTENTIAL TOXINS, AND HE ADMITTED TO THE INGESTION OF
ACKEE FRUIT, A NATIVE JAMAICAN FRUIT THAT IS ILLEGAL IN THE UNITED STATES. SHORTLY AFTER HE HAD CEASED INTAKE OF THE FRUIT, HIS SYMPTOMS RESOLVED AND HIS LIVER FUNCTION TESTS RETURNED TO NORMAL. WE PRESENTED A CASE OF CHRONIC ACKEE FRUIT
INGESTION THAT LED TO CHOLESTATIC JAUNDICE, VOMITING, AND ABDOMINAL PAIN. |