![](https://d3ilqtpdwi981i.cloudfront.net/0hSIgnGMBHF9SSHXJCOEw1VNeMI=/0x0:200x258/425x550/smart/https://bepress-attached-resources.s3.amazonaws.com/uploads/f9/0b/e0/f90be0e8-9b9c-4015-b17b-f10492de96b9/ictx20.v056.i10.cover.jpg)
Introduction: Steroidal alkaloids are found in plants of the genus Veratrum. Their toxicity manifests as gastrointestinal symptoms followed by a Bezold–Jarisch reflex: hypopnea, hypotension, and bradycardia. Some Veratrum steroidal alkaloids are also teratogens interfering with the hedgehog-2 signaling pathway, which causes cyclopsia and holoprosencephaly. We present a case of accidental poisoning from Veratrum parviflorum mistaken for the edible Allium tricoccum (ramps, wild leek).
Case history: A 27-year-old man and his 25-year-old wife presented to the emergency department with nausea, vomiting, hypotension, and bradycardia after foraging and ingesting plants that they believed to be a local native species of wild leek.
Methods: We collected and analyzed the implicated fresh plant material and both patients’ serum/plasma. We used liquid chromatography–mass spectroscopy and high-resolution electrospray ionization time of flight tandem mass spectrometry to extract and characterize steroidal alkaloids from the foraged plant and patients’ serum.
Results: Our V. parviflorum samples contained verazine, veratramine, veratridine, and cyclopamine.
Discussion: Steroidal alkaloids have been previously isolated from Veratrum viride and Veratrum album and toxicity has been reported mainly from V. album species.
Conclusion: V. parviflorum toxicity manifests with gastrointestinal and cardiac symptoms. Treatment is symptomatic and supportive as with previous case reports of toxicity with other Veratrum species.
Available at: http://works.bepress.com/owen_mcdougal/52/