An unusual case of anisocoria by vegetal intoxication: a case report

Marina Macchiaiolo,Diletta Valentini,Alberto Villani,Annalisa Grandin,Michaela V Gonfiantini,Maria Romano,Elettra Vignati,Michele Salata

doi:10.1186/1824-7288-36-50

Marina Macchiaiolo, Diletta Valentini + Show 6 more

Open Access

https://doi.org/10.1186/1824-7288-36-50

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Abstract

A 12 year old boy presented with an acute onset of anisocoria and blurred vision. Ocular motility was normal but his right pupil was dilated, round but sluggishly reactive to light. There was no history of trauma, eye drops' instillation, nebulised drugs or local ointments. His past medical history was negative.A third nerve palsy was considered but the performed cerebral MRI was normal.On further anamnestic investigation the boy revealed that he had spent the morning doing gardening, and especially working on a "trumpet plant". Datura and Brugmansia are well known toxic plant; all Datura and Brugmasia plants contain, primarily in their seeds and flowers, tropane alkaloids such as scopolamine, hyoscyamine and atropine. Systemic and local intoxications have already been described.The day after anisocoria was much less evident and completely resolved in three days.We present this case of an unusual cause of mydriasis to underline once more the importance of a well and deeply conducted medical history.

Highlights

A 12 year old boy presented with an acute onset of anisocoria and blurred vision
Case report A 12 year old boy presented to the emergency for the onset of acute anisocoria
Two hours before the boy had started to complain of a blurred vision; his mother, a paediatric nurse, noticed a pupil asymmetry with a clearly dilated right pupil (Figure 1)

Summary

Introduction

A 12 year old boy presented with an acute onset of anisocoria and blurred vision. Ocular motility was normal but his right pupil was dilated, round but sluggishly reactive to light. The day after anisocoria was much less evident and completely resolved in three days We present this case of an unusual cause of mydriasis to underline once more the importance of a well and deeply conducted medical history. There was no history of trauma, eye drops’ instillation, nebulised drugs or local ointments. The patient was diagnosed with pharmacologic mydriasis secondary to unintentional contact with Datura suaveolens ; no further investigations were performed and the boy completely recovered

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