Fulminant Hepatitis Revealing Carob Intoxication: A Case Report

Abstract

A 34-year-old man with a history of obsessive-compulsive disorder was admitted with febrile altered consciousness and generalized mucocutaneous jaundice. His condition was attributed to excessive consumption of Ceratonia siliqua (also known as carob), which he believed had digestive benefits. On examination, he had an altered consciousness with a Glasgow Coma Scale evaluation at 8/15, was hemodynamically stable, and exhibited adequate respiratory function. Laboratory findings revealed severe hypoglycemia, hepatocellular failure with marked cytolysis, and a critically low prothrombin level, while viral serologies were negative and renal function remained normal. A cranial CT scan showed no abnormalities. In the absence of an identifiable cause for fulminant hepatitis, carob intoxication was suspected. The patient received mechanical ventilation, supportive care with 10% glucose infusion, vitamin K therapy, prophylactic ceftriaxone, laxatives, and plasmapheresis for five days. Despite intensive management, his condition deteriorated, and he succumbed to acute liver failure.