• James Espinosa, Alan Lucerna, and Robert Bassett.
• Department of Emergency Medicine, Rowan University SOM/Jefferson Stratford - Stratford, NJ, USA. Electronic address: Jim010@aol.com.
• Am J Emerg Med. 2022 Oct 1; 60: 225.e5225.e6225.e5-225.e6.

AbstractHere we present the case of a 4-year-old child who presented to the emergency department (ED) with bloody diarrhea. The causative agent was confirmed to be Citrullus colocynthis (bitter apple), which had been given to the patient by his grandmother for constipation. Hemorrhagic colitis can be induced by Citrullus colocynthis. Treatment is essentially support. Hypoglycemia and transaminitis have been associated with Citrullus colocynthis ingestion. The case highlights that pediatric patients can be inadvertently exposed to herbal medications that can cause harm. It also highlights that certain herbal medications with toxic potential, such as Citrullus, can be seen in emergency departments that are geographically quite distant from the most common origins of the plant. To our knowledge, this is the first American pediatric case report of bitter apple induced hemorrhagic colitis.Copyright © 2022. Published by Elsevier Inc.

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