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Ipomoea Asarifolia) Due to Misidentification As ‘Kankun’ (Ipomoea Aquatica)

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Ipomoea Asarifolia) Due to Misidentification As ‘Kankun’ (Ipomoea Aquatica) Case reports Discussion persistent normal level of AFP after the chemotherapy. Sacrococcygeal region, mediastinum, retro- She will be followed up for her life time to monitor the side peritoneum and other pelvic organs are the common sites effects of the drugs and tumour recurrence. The for a primary extragonadal GCT in paediatric age group management of these highly treatable cardiac tumours [1]. GCTs have many histological types according to demands a strong multidisciplinary approach to deal with cellular differentiation and grade. Myocardium is an unanticipated complications of the tumour and the extremely rare site of origin for an extra gonadal GCT treatment. and only 3 cases have been reported. All previously documented tumours are also yolk sac or predominantly References yolk sac in origin [3,4,5]. Our patient differs from the previously reported cases in that the tumour was arising 1. Ries LA, Smith MA, Gurney JG, et al. eds. Cancer incidence from the endocardium and focally infiltrating the myo- and survival among children and adolescents: United States cardium rather than originating in the myocardium itself. SEER Program 1975-1995. Bethesda, Md: National Cancer Institute. 1999: 125-35. Even though these tumours are highly treatable, management of intracardiac tumours are often complicated 2. Göbel U, Bamberg M, Engert J, et al. Treatment of non- by the cardiac problems such as cardiac failure, tamponade testicular germ cell tumors in children and adolescents with or arrhythmias. The echocardiographic appearance of an BEP and VIP: initial results of the MAKEI 89 therapy intracardiac tumour within a period of 3 months in itself study. Klinische Padiatrie 1991; 203: 236-45. hints at its malignant potential. Therefore, an open surgery 3. Melinda JM, Richard AH, William SF, James WZ. was performed to excise the tumour and to close the ASD. Intracardiac yolk sac tumor and dysrhythmia as an etiology Because of the deep infiltration of the tumour into the of pediatric syncope. Pediatrics 2004; 113: 374-6. inter-atrial and ventricular septa, an extensive surgery was 4. Graf M, Blaeker H, Schnabel P, et al. Intracardiac yolk sac performed to maximally debulk the tumour knowing it could tumor in an infant girl. Pathology, Research and Practice damage the conductive pathway. 1999; 195:193-7. The tumour marker, AFP was extremely helpful in 5. Parvathy U, Balakrishnan KR, Ranjith MS, et al. Primary assessing the tumour response to chemotherapy. intracardiac yolk sac tumor. Pediatric Cardiology 1998; 19: Complete response to chemotherapy was indicated by 495-7. Poisoning of ‘binthamburu’ (Ipomoea asarifolia) due to misidentification as ‘kankun’ (Ipomoea aquatica) A Ratnatilaka1, D Yakandawala2, N Rupasinghe1 and K Ratnayake1 (Index words: Ipomoea asarifolia, food poisoning) Abstract reveal the difference in their leaf shapes. Ipomoea asarifolia toxicity in human has not been recorded but Ingestion of ‘Binthamburu’ (Ipomoea asarifolia) by animal toxicity in North Brazil due to ingestion of Ipomoea misidentification as ‘kankun’ (Ipomoea aquatica) as a asarifolia had been investigated and linked to a toxic leafy vegetable causes acute gastrointestinal symptoms substance identified as lectin or LTS. and confusion. The authors have encountered four such cases in the past. All cases have been recorded from the dry zone of the country. Both plants are two trailing vines similar in their appearance and preferring the wet Introduction habitats. During the course of the day when exposed to ‘Binthamburu’ (Ipomoea asarifolia) and ‘kankun’ sunlight, ‘binthamburu’ leaves mimic ‘kankun’ leaves (Ipomoea aquatica) belong to the same genus of the by folding the leaf margins making it difficult to separate the two during harvest and only a closer examination will family Convolvulaceae. Both plants prefer wet habitats, 1Medical Unit, Teaching Hospital Kurunegala, and 2Faculty of Science, University of Peradeniya, Sri Lanka. Correspondence: DY, e-mail <[email protected]>. Received 11 August and accepted 17 November 2009. Competing interests: none declared. 54 Ceylon Medical Journal Case reports Acknowledgments 3. Medeiros RM, Barbosa RC, Tabosa IM, et al. Tremorgenic syndrome caused by Ipomoea asarifolia in Northeastern Authors wish to thank Indika Peabotuwage for the Brazil. Toxicon 2003; 41: 933-5. botanical illustrations of the leaves. 4. Markert A, Steffan N, Ploss K. Biosynthesis and accumulation of ergoline alkaloids in a mutualistic association References between Ipomoea asarifolia (Convolvulaceae) and a clavicipitalean fungus. Plant Physiology 2008. 1. Jayaweera DMA. Medicinal Plants used in Ceylon, Part 2. http://lib.bioinfo.pl/pmid:18344419 (accessed in November The National Science Council of Sri Lanka. Colombo. 1980. 2008) P. 98 -101. 5. Rech RR, Rodrigues A, Rissi DR. Poisonous plants affecting 2. Vasconcelos IM, Santos LFL, Oliveira JTA, et al. Purification the central nervous system (CNS) of cattle in Brazil. 2007. of a leaf lectin as a neurotoxic constituent of Ipomoea http://CAB Abstracts.htm (accessed in November 2008.) asarifolia. 2001. 6. Austin DF. Convolvulaceae. In: Dassanayake MD, Fosberg, http://plab.ku.dk/tcbh/interlec19abstracts1.pdf (accessed in FR, eds. A Revised Hand Book to the Flora of Ceylon. New November 2008). Delhi: Amerind Publishing Co. Pvt. Ltd. 1980: 288-363. An uncommon complication of Salmonella paratyphi A infection S Subasinghe1 and J Indrakumar2 (Index words: Infective endocarditis, enteric fever, Salmonella paratyphi) Introduction investigated for an incidental murmur one year ago. He Infective endocarditis (IE) is a rare complication of enteric had no significant illnesses in the past. fever. Salmonella typhi is the organism that causes enteric On admission he had high fever of 104°C. He was not pale fever in most patients. Although IE due to Salmonella or icteric. There were no signs of heart failure or evidence typhi has been reported [1,2] only four cases of IE due to of any embolic phenomena. His pulse rate was 100 beats Salmonella paratyphi have been documented [3-6]. Of per minute and blood pressure was 100/70 mmHg. Cardiac these four cases, two were in the paediatric age group and examination revealed a grade 2 late systolic murmur over one had a pre existing cardiac lesion. In Sri Lanka IE caused the apex and left lower sternal border consistent with a by Salmonella typhi has been reported [7] but not by mitral valve prolapse. On abdominal examination he had a Salmonella paratyphi. We report a case of an infective 3 cm, non-tender liver and a mild splenomegaly. endocarditis due to Salmonella paratyphi A with full Laboratory tests showed an elevated white cell count of recovery after appropriate antibiotic treatment. 17 000/mL with neutrophils of 73.5%; a haemoglobin level of 11.9 g/dl; an elevated ESR level (55 mm/1 hr) and raised Case report AST and ALT of 86 and 87 IU/L respectively. Renal functions, urine full report, chest radiograph and The patient was a 25-year old man admitted with abdominal ultrasound scan were normal. Transthoracic intermittent fever of 10 days duration. He had been well echocardiography showed definite vegetations on the until 10 days before when he developed fever. The fever anterior leaflet of the mitral valve and moderate mitral was associated with chills, malaise, headache and body regurgitation. The ejection fraction was normal (60%). Of aches. He did not have any other symptoms attributable the three blood cultures taken on the second day only to specific organ system. On the third day of the fever he one yielded a growth of Salmonella paratyphi A. This consulted a general practitioner and a 3-day course of organism found to be sensitive to ampicillin, cefotaxime, antibiotics had been given. The fever persisted in spite of cotrimoxazole and chloramphenicol. Based on clinical and this treatment. He was already diagnosed to have a mitral laboratory findings (vegetation on the mitral valve, fever, valve prolapse with mitral regurgitation when he was predisposing heart valve condition and microbiological 1University Medical Unit, Colombo South Teaching Hospital, and 2Department of Medicine, Faculty of Medical Sciences, University of Sri Jayawardenepura, Sri Lanka. Correspondence: JI, e-mail <[email protected]>. Received 28 August and accepted 26 December 2009. Competing interests: none declared. 56 Ceylon Medical Journal.
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