Severe toxin mediated thrombotic microangiopathy after consumption of processed Ceylon olive (Elaeocarpus serratus); A case report

Thrombotic microangiopathy (TMA) is a diverse group of disorders where the pathophysiology is thrombosis in microvasculature. Snake and bee venom-induced TMA is known, but food toxin-induced TMA was not reported. A 23-year-old girl presented with severe anemia after eating processed Ceylon olive (Elaeocarpus serratus) 4 days back. Her exposure to any other known causative factor for TMA was excluded. Her hemoglobin was 6.5 g/dL, and her platelet was 5x10³/µL. She was treated with blood and platelet transfusions. But post-transfusion hemoglobin dropped to 4.5 g/dL, while the platelet count increased to 165 x10³/L, which suggested ongoing hemolysis. The blood picture showed microangiopathic hemolytic anemia. Lactate dehydrogenase (LDH) was very high. She developed acute kidney and lung injuries during the course of her illness and management.  With supportive care, four cycles of therapeutic plasma exchanges, and intravenous methylprednisolone pulses, she recovered. This case adds a novel dimension to TMA pathophysiology and management. It underscores the need for clinicians to remain vigilant about atypical causes of TMA including food toxin, which has not been widely reported in medical literature. This also highlights the importance of early diagnosis and intervention such as therapeutic plasma exchange to reduce morbidity and mortality.