Ecbalium elaterium (squirting cucumber) - Remedy or poison?

Background: Ecbalium elaterium is a plant endemic to the Mediterranean basi n. Its roots and cucumber-shaped fruit have been used in folk medicine sinc e antiquity. The alleged uses of the fruit juice are as a potent cathartic, analgesic, and antiinflammatory agent. Cucurbitacin B, a triterpene deriva tive is the active antiinflammatory principal. Patients: We present a serie s of 13 patients who were exposed to the juice of Ecbalium elaterium in its natural form. In 3 patients, exposure was intranasal for the treatment of sinusitis or liver cirrhosis. In 3 other casts, children ingested the fruit unwittingly. In 6 patients, exposure was ocular and, in one, dermal. Withi n minutes of exposure, the patients exhibited irritation of mucous membrane s at various degrees of severity manifested as edema of pharynx, dyspnea, d rooling, dysphagia, vomiting, conjunctivitis, corneal edema, and erosion, d epending on the route of the exposure. Recovery began within several to 24 hours after administration of oxygen, steroids, antihistamines, and beta-2- agonists. Ocular exposures responded to topical steroid and antibiotic eyed rops within a few days. The toddler with the dermal exposure remained asymp tomatic. Conclusion: Exposure to the juice of Ecbalium elaterium, mainly in its undiluted form, may cause irritation of mucous membranes, supposedly o f inflammatory nature. Patients exposed orally or intranasally should be cl osely followed for upper airway obstruction. Patients exposed ocularly shou ld have their eyes promptly irrigated to prevent corneal and conjunctival i njury.