Case Report: Alocasia poisoning presenting with marked QTc prolongation and a MINOCA-like phenotype
Abstract
A 75-year-old woman accidentally ingested approximately 10 g of the rhizome of Alocasia macrorrhizos. Within seconds, she developed oral numbness, throat swelling, sialorrhea, dysphagia, and heartburn. She immediately rinsed her mouth with copious amounts of water and presented to a local clinic. An electrocardiogram (ECG) obtained there was normal, with a corrected QT interval (QTc) of 400 ms. Following treatment with anti-allergic therapy, her symptoms resolved. Approximately 26 h after ingestion, she developed persistent, progressive substernal chest pressure. Upon presentation to our hospital (28 h post-ingestion), her cardiac troponin I (cTnI) level was 0.352 ng/mL, while myocardial enzymes and D-dimer were within normal limits. The ECG revealed diffuse T-wave inversions and a markedly prolonged QTc interval of 590 ms. Coronary angiography showed no obstructive lesions and normal coronary flow. Echocardiography demonstrated reduced wall motion in the mid-segment of the left ventricular anterior wall, consistent with a MINOCA-like phenotype. A final diagnosis of toxic myocardial injury was made. Following supportive care, including continuous ECG monitoring, myocardial metabolic support, and rate control with low-dose metoprolol, her chest pain completely resolved approximately 124 h after ingestion. The QTc interval normalized to 440 ms, T-wave inversions became less pronounced, and regional wall motion abnormalities resolved. At a 2-week follow-up, the QTc interval was…
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