Citation

Farag M, Badowski D, Koschny R, Skopp G, Brcic A, Szabo GB. Am. J. Emerg. Med. 2017; 35(12): 1987.e3-1987.e7.

Copyright

(Copyright © 2017, Elsevier Publishing)

DOI

10.1016/j.ajem.2017.09.031

PMID

28941873

Abstract

INTRODUCTION: Yew plants are evergreen shrubs which are widely spread throughout the northern hemisphere. Taxane alkaloid derivatives, mainly taxine B, represent the main toxins of Taxus baccata and are highly cardiotoxic. Due to the lack of randomized clinical trials, case reports on accidental or suicidal yew intoxications build the only source of knowledge of clinical treatment options.
CASE REPORT: We report the case of a suicidal yew ingestion admitted to our hospital under prolonged cardiopulmonary resuscitation due to pulseless electrical activity. Extra-corporeal life support (ECLS) was established to maintain adequate organ perfusion. Repeated administration of digoxin-specific Fab antibody fragments, which cross-react with taxine, was associated with an immediate conversion from asystole to broad-complex bradycardia and a gradual normalization of the electrocardiogram (ECG). This was paralleled by a recovery of the cardiac function and weaning from the ECLS. The taxine metabolite 3,5-dimethoxyphenol could be detected by mass spectrometry before but not after the first Fab-fragment treatment. In contrast, the total amount of taxine (including the neutralized, Fab fragment-bound fraction) was increased after each Fab fragment administration, suggesting an accumulation of neutralized, since antibody-bound taxine in the blood by anti-digoxin Fab fragments.
DISCUSSION: In conclusion, the successful clinical course of this case suggests a benefit of an early anti-digoxin Fab-fragment administration for the treatment of yew intoxication.

Language: en

Keywords

Humans; Female; Intoxication; Young Adult; Treatment Outcome; Extracorporeal Membrane Oxygenation; Suicide, Attempted; Electrocardiography; Renal Dialysis; Acute Kidney Injury; Mass Spectrometry; Plant Leaves; Arrhythmias, Cardiac; Taxus baccata; Yew; Taxine; Immunoglobulin Fab Fragments; Taxus; Plant Extracts; Pancreatectomy; Splenectomy; Digoxin-specific Fab antibody fragments; Extra-corporeal life support