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Meningism look alike Annona Muricata (Graviola) Poisoning

Author: Zainul Ikhwan Ahmad Khusairi

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Zainul Ikhwan Ahmad Khusairi¹, Mohd Affendi Mohd Ghazali¹

Annona muricata is a member of the Annonaceae family and is a fruit tree with a long history of traditional use. A. muricata, also known as soursop, Graviola and guanabana, is an evergreen plant that is mostly distributed in tropical and subtropical regions of the world. Graviola has very broad medicinal claims and is also widely consumed as a food and in drinks in the tropics. The plant produces a wide range of secondary chemicals, some already known to be toxic. Concerning this, one case has been reported recently in the Emergency Department, Taiping Hospital who suffered from sudden onset of neurotoxin symptoms after drinking a homemade Graviola leaves juice then presented to ED with the complaint of high-grade fever and altered mental status with other gastrointestinal symptoms such as diarrhoea and vomiting. The patients’ health was good before drinking the Graviola drinks. On arrival, he was confused with a sign and symptoms of neurotoxic hence the patient was treated initially as Meningitis. Blood pressure was in the normal range but the pulse rate around 120-130bpm with spiking in temperature reading (41.8◦C). Neck stiffness was noted with no other neurological deficit. Pupil 3 mm equal bilaterally, while lung and cardiovascular were normal. The abdomen was soft but the discomfort was described as bloated and discomfort upon palpation. Patient was resuscitated with normal saline and an antibiotic was started. He was then admitted to the medical ward and lumbar puncture suggest meningitis and antibiotic treatment was continued until he got discharged. Therefore, all patients with a history of Graviola neurotoxin symptoms should be admitted. The levels and chemicals found in these leaves need to be studied in detail to identify more specific signs and symptoms. This is to provide more accurate and effective medical treatment to patients and prevent more serious complications.

Keywords: Neurotoxin, Meningitis, Graviola, Emergency Department Hospital Taiping.


1.Emergency and Trauma Department, Taiping Hospital, Perak Darul Ridzuan, Malaysia


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