# Anticholinergic Toxidrome Following Indirect Exposure to Hyoscyamus muticus Through Grasshopper Ingestion: A Case Report

## TL;DR

A man and his son developed anticholinergic symptoms after eating a grasshopper that had fed on a toxic plant, highlighting an unusual exposure route.

## Contribution

Reports a rare case of anticholinergic toxidrome from indirect exposure to Hyoscyamus muticus via grasshopper ingestion.

## Key findings

- Symptoms consistent with anticholinergic toxidrome occurred after grasshopper ingestion.
- Both patients recovered fully with conservative management and no antidotal therapy.
- The case emphasizes the importance of considering indirect plant toxin exposure in clinical evaluations.

## Abstract

Anticholinergic toxidrome is a well-recognized clinical syndrome resulting from the inhibition of muscarinic receptors by substances such as tropane alkaloids, which are found in certain toxic plants like Hyoscyamus muticus (Egyptian henbane). While direct plant ingestion is a common cause, indirect exposure through ingestion of animals that have consumed toxic plants is extremely rare.

We report a rare case of a 43-year-old man and his 10-year-old son who presented to the emergency department with symptoms of anticholinergic toxidrome, including blurred vision, dry mouth, nausea, and abdominal discomfort, after ingesting a grasshopper observed feeding on H. muticus. The father had no medical history, while the child had a known seizure disorder controlled on medication. Both patients were hemodynamically stable and exhibited classic mild anticholinergic signs. Routine investigations were unremarkable. They were managed conservatively with supportive care, and both recovered fully without the need for antidotal therapy.

This case highlights a rare but important route of exposure to anticholinergic toxins through the food chain via insect ingestion. Clinicians should maintain a high index of suspicion for plant-based toxins in atypical presentations and consider indirect routes of exposure, especially in rural settings. Thorough history-taking remains essential in identifying environmental or dietary sources of toxic exposure.