Abstract
A male in his 20s with no medical history was found with generalised seizures and profound hypoglycaemia after consuming improperly stored, reheated rice.
Initial laboratory tests showed acute liver failure with hyperammonaemia, acute kidney injury and lactic acidosis, which rapidly progressed to multi-organ failure requiring urgent liver transplantation evaluation.
With maximal supportive therapy, including glucose, ammonia and glutamine scavengers, renal replacement therapy, haemodynamic and respiratory support, he gradually improved, avoiding transplantation and achieving full neurological recovery. Toxicological analysis of the rice and serum revealed high concentrations of cereulide, a toxin produced by
Bacillus cereus
. This case illustrates that cereulide intoxication can be associated with potentially fatal multi-organ failure, particularly after ingestion of improperly stored starchy foods.
Early recognition through targeted dietary history, focused laboratory evaluation and prompt supportive therapy are essential. Increasing awareness among healthcare professionals and safe food storage practices are key preventive measures.