CLINICAL SPECTRUM AND MANAGEMENT OF CITRULLUS COLOCYNTHIS (KUMATIKKAI) POISONING: A CASE SERIES FROM SOUTH INDIA

Abstract

Citrullus colocynthis (commonly known as Kumatikkai or Bitter Apple) is a toxic member of the Cucurbitaceae family, often mistaken for edible melons or gourds in rural India. Accidental or intentional ingestion of its fruit can result in a range of clinical manifestations, from mild gastrointestinal upset to severe hemorrhagic colitis and hepatic dysfunction.

Objective: To describe the clinical spectrum, diagnostic features, and management outcomes of Citrullus colocynthis poisoning based on a series of seven cases admitted to Government Rajaji Hospital, Madurai.

Methods: A retrospective case series of seven patients (ages 13–42) presenting with confirmed C. colocynthis ingestion between April and September 2025 was analyzed. Data on exposure type, quantity ingested, clinical presentation, laboratory/imaging findings, treatment, and outcomes were collected and reviewed.

Results: Of the seven cases, five were accidental ingestions and two were intentional. Common symptoms included nausea (100%), vomiting (71%), abdominal pain (57%), diarrhea (43%), and hematochezia (29%). Two patients developed hemorrhagic colitis confirmed by CECT imaging. Three patients exhibited transient hepatic dysfunction with elevated bilirubin levels, one peaking at 4.0 mg/dL. All patients received supportive management including IV fluids, antiemetics, proton pump inhibitors, and ursodeoxycholic acid where indicated. Antibiotics were administered in cases with radiological evidence of colitis. No fatalities occurred, and all patients recovered fully.

Conclusion: Kumatikkai poisoning presents with a broad clinical spectrum, ranging from mild gastrointestinal symptoms to colitis and hepatic dysfunction. While the prognosis is generally favorable with early supportive care, public awareness and accurate plant identification are crucial to prevent accidental ingestions. Clinicians should maintain a high index of suspicion in endemic areas to enable prompt diagnosis and management.