{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:26:43Z","timestamp":1787030803936,"version":"build-2736575974"},"reference-count":51,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T00:00:00Z","timestamp":1786838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009663","name":"University Health Network","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100009663","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/042xt5161","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003579","name":"University of Toronto","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003579","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/03dbr7087","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int. J. Environ. Res. Public Health","IJERPH"],"abstract":"<jats:p>Manchineel dermatitis, caused by the sap of the manchineel tree native to the coastlands of the Caribbean, West Africa, and Central America, has received limited attention in the literature despite significant morbidity. The toxic sap causes a burning, blistering rash and conjunctivitis, while ingestion of the fruit may lead to oropharyngeal pain, hemodynamic instability, and gastrointestinal distress. Tourists unfamiliar with the manchineel tree may be exposed through exposure to the tree\u2019s sap, contaminated rainwater, or ingestion of the apple-like fruit. We herein present a case of a patient who experienced prolonged symptoms of manchineel toxicity after ingestion of the manchineel fruit for several weeks. Antihistamines, corticosteroids, and a PPI were ineffective. The symptoms eventually resolved after discarding clothing and towels that had come in contact with the tree, raising the possibility that toxins may linger on fabrics. Travellers to regions in the Caribbean or Central America are at particular risk for toxicity from the Manchineel tree if unfamiliar with the associated dangers and should be counselled to avoid contact with the tree or ingesting any unfamiliar fruit on the ground. When exposures do occur, it may be reasonable to dispose of potentially contaminated fabrics to avoid recurrent exposures, particularly if recurrent symptoms are observed, as in our patient. We further contextualize manchineel toxicity within a comparative review of select tropical foodborne intoxications of plant origin (ackee, lychee, cassava, papain) and marine origin (ciguatera, scombroid, neurotoxic and diarrhetic shellfish poisonings, tetrodotoxin), distinguishing manchineel\u2019s local irritant mechanism from the systemic toxidromes of these comparators and underscoring the absence of a specific antidote.<\/jats:p>","DOI":"10.3390\/ijerph23081062","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T08:05:41Z","timestamp":1786953941000},"page":"1062","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Poison Apple-like Fruit Ingestion: A Case Report and Review of Manchineel Fruit Toxicity"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3586-746X","authenticated-orcid":false,"given":"Amanda K.","family":"Hempel","sequence":"first","affiliation":[{"name":"Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahel","family":"Zewude","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Klowak","sequence":"additional","affiliation":[{"name":"Institute of Medical Science, University of Toronto, Toronto, ON M5S 3H2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahyreem","family":"Shahid","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7888-5406","authenticated-orcid":false,"given":"Judith","family":"Joshi","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongtian","family":"Shao","sequence":"additional","affiliation":[{"name":"School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2720-6944","authenticated-orcid":false,"given":"Andrea K.","family":"Boggild","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada"},{"name":"Institute of Medical Science, University of Toronto, Toronto, ON M5S 3H2, Canada"},{"name":"Tropical Disease Unit, Toronto General Hospital, Toronto, ON M5G 2C4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,16]]},"reference":[{"key":"ref_1","first-page":"346","article-title":"Manchineel Apple of Death","volume":"30","author":"Muskat","year":"2019","journal-title":"eJIFCC"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.toxicon.2019.02.014","article-title":"Severity of Manchineel Fruit (Hippomane mancinella) Poisoning: A Retrospective Case Series of 97 Patients from French Poison Control Centers","volume":"161","author":"Cachet","year":"2019","journal-title":"Toxicon"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1136\/bjo.77.5.284","article-title":"Manchineel Keratoconjunctivitis","volume":"77","author":"Pitts","year":"1993","journal-title":"Br. 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