Accidental ingestion of plants and seeds by children are not uncommon and can result in significant symptoms necessitating hospital admission and emergency treatment. Indian data on the exact proportion of poisoning due to these toxic plants are not available. The Araceae family of plants is the major cause of symptomatic plant ingestions in some developed countries (Dieffenbachia and Philodendron) and in Zimbabwe (Elephant’s Ear), especially in children [1]. A case of Dieffenbachia plant (Dumb cane) ingestion followed by severe tongue swelling is presented.

A nine-year-old boy was brought to the emergency department with history of severe irritation and pain in the mouth with difficulty in swallowing and drooling of saliva. The onset was acute, subsequent to chewing of a portion of a leaf and the stem of a nearby plant accidentally while playing in a park. Child’s parents attributed the symptoms to this incident and carried both the leaf and the stem to the emergency department (Fig. 1). On examination the boy had severe pain in the mouth and throat with dysphagia. There was no compromise of airway. He had severe upper abdominal pain also. Within a span of one hour, he developed extensive erythema of the mucus membrane of the mouth and throat with severe swelling of the tongue. The plant was identified as Dieffenbachia and the clinical profile observed matched with the consumption of the leaf of this toxic ornamental plant.

Fig. 1 Dieffenbachia plant leaf and the stem.

The boy was admitted and treated with intravenous fluids, analgesics, antacid, antihistaminic and ranitidine. He was not able to take anything orally for two days. From third day onwards, the swelling and the redness of the tongue reduced, pain abdomen subsided and he was able to tolerate liquid diet. Whitish grey slough that had formed started disappearing from the tongue gradually, leaving erythematous, sore areas. He made uneventful recovery and was discharged after four days.

Ingestions involving the Dieffenbachia plant from Arum family are associated with the development of intense irritation of mucous membranes, resulting in swelling of the tongue, lips and palate. Dieffenbachia causes severe local injury to the tissues due to the oxalate crystals contained in the plant juice. In severe cases there may be even airway compromise. Among 188 cases of toxic plant ingestions identified by Mrvos, et al.[2], the integrity of the leaf had been broken in all cases and dieffenbachias accounted for 32.5% of the cases. Majority of the involved children were aged 4-12 months. Only 2.1% (4 cases, Dieffenbachia-3, Philoden-dron-1) of the patients were severely symptomatic [2]. In a series from Switzerland, Dieffenbachia poisoning accounted for 11 cases with severe stomatitis in eight and corneal lesions in three patients [3].

When ingested, the common house plant dieffenbachia can lead to significant toxicity and possibly death if timely medical attention is not forthcoming following initial exposure. The deleterious effects should not be overlooked, especially when children are involved who may bite into this innocuous looking plant [4]. Close observation is required to prevent progressive swelling of tongue and adjacent tissues interfering with the airway. Educating the people about the toxicity of Dieffenbachia is crucial in view of the wide spread indoor use of this ornamental plant.

1. Tagwireyi D, Ball DE. The management of Elephant’s Ear poisoning. Hum Exp Toxicol. 2001;20:189-92.

2. Mrvos R, Dean BS, Krenzelok EP. Philodendron/dieffenbachia ingestions: are they a problem? J Toxicol Clin Toxicol. 1991;29:485-91.

3. Jaspersen-Schib R, Theus L, Guirguis-Oeschger M, Gossweiler B, Meier-Abt PJ. Serious plant poisonings in Switzerland 1966-1994. Case analysis from the Swiss Toxicology Information Center. Schweiz Med Wochenschr. 1996;126:1085-98.

4. Pamies RJ, Powell R, Herold AH, Martinez J. The dieffenbachia plant. J Fla Med Assoc. 1992;79:760-1.