Bottle Gourd – A Poison in Disguise

Background: Bottle gourd (Lagenaria siceraria) is widely promoted in traditional Indian medicine for its purported health benefits, including use in managing diabetes, hypertension, liver disorders, and gastrointestinal ailments. However, under certain conditions, the juice can turn bitter due to elevated concentrations of cytotoxic compounds known as cucurbitacins. These compounds are highly toxic to humans and can cause severe gastrointestinal and systemic symptoms. Case Presentation: We report the case of a 45-year-old male who routinely consumed bottle gourd juice. On the day of presentation, he consumed an unusually bitter juice. Within 15 minutes, he developed severe vomiting, epigastric discomfort, headache, and profuse sweating. He arrived at the Emergency Department hemodynamically stable but soon developed altered sensorium, hypotension, and tachycardia. ECG changes (S1Q3T3 pattern) and elevated D-dimer raised concerns for pulmonary embolism, and a CTPA was planned. However, the scan was aborted due to sudden hematemesis. Initial labs showed leukocytosis and deranged liver function. Endoscopy revealed diffuse gastric erythema, fluid accumulation, and a suspicious ulcer with a clot on the lesser curvature. The patient was managed conservatively with IV fluids, inotropes, PPIs, antiemetics, and antibiotics. He improved over the next few days and was discharged in a stable condition. Conclusion: This case underscores the potential lethality of consuming bitter bottle gourd juice. Physicians should suspect cucurbitacin poisoning in patients presenting with acute GI symptoms, hypotension, and recent consumption of Cucurbitaceae family plants. There is no antidote; early recognition and supportive care remain the mainstay of treatment. Public awareness is crucial to prevent further morbidity and mortality.