Hyoscyamus niger poisoning in Sudan: A case report

Introduction

Hyoscyamus niger, a member of the Solanaceae family, has a long history of medicinal and hallucinogenic use. It is commonly known as henbane and contains potent alkaloids such as hyoscyamine and scopolamine, which can lead to anticholinergic syndrome when ingested. ¹ This report discusses a case of H. niger poisoning in a male gardener who mistakenly ingested parts of the plant.

Case presentation

A 35-year-old male gardener with no significant past medical history presented to our emergency department with symptoms of confusion, hallucinations, dry mouth, and dilated pupils. According to his family, he had ingested parts of an unfamiliar plant while working. On examination, his vital signs revealed a fever of 37.8 °C, tachycardia of 120 beats per minute, blood pressure of 145/90 mmHg, tachypnoea of 18 breaths per minute, and oxygen saturation of 98% on room air.

His physical examination showed a confused, disoriented, and agitated man with visual hallucinations. His pupils were dilated and non-reactive to light. His skin was flushed and dry, and his mucous membranes were dry. There were no cardiac murmurs and decreased bowel sounds.

Laboratory investigations showed a full blood count within normal limits, mild hypernatraemia (Na⁺ 148 mmol/L), and normal renal and liver function tests. His urine toxicology screen was negative for common drugs of abuse. An electrocardiogram showed sinus tachycardia.

Based on the history of plant ingestion, clinical presentation, and exclusion of other common toxic agents, a diagnosis of H. niger (henbane) poisoning was made.

He was rehydrated and given activated charcoal to reduce further absorption of toxins. Lorazepam was given for agitation and seizures, and physostigmine, an acetylcholinesterase inhibitor, at 0.5 mg IV, repeated every 15–30 min as needed, based on clinical response to counteract the anticholinergic effects.

Within 30 min, he started to improve; his heart rate normalised, and he became more alert and oriented. Over the next 24 h, his symptoms continued to resolve. He was monitored for another 48 h. At a follow-up visit one week later, he had completely recovered with no residual effects.

Discussion

H. niger poisoning, though rare, can result in severe anticholinergic syndrome. ² Rapid identification and treatment are therefore critical for patient recovery. The use of physostigmine is particularly effective in reversing central and peripheral anticholinergic effects, though its administration must be carefully monitored owing to potential side effects.^3,4

This case highlights the importance of recognising plant-based poisoning; education about the dangers of unfamiliar plants, especially among individuals who work in environments where such plants may be encountered, is essential.