Leftover rice toxin caused liver failure and seizures in a healthy young man

A man in his 20s with no medical history was found having generalised seizures and severe hypoglycaemia after eating improperly stored, reheated rice. Tests showed acute liver failure with high ammonia, acute kidney injury and lactic acidosis. He rapidly progressed to multi-organ failure, and liver transplantation was being evaluated.

He received intensive supportive care, including glucose, ammonia and glutamine scavengers, renal replacement therapy, and circulatory and respiratory support. He gradually improved, did not need a transplant and recovered fully neurologically. Toxicology found high concentrations of cereulide, a toxin made by Bacillus cereus, in both the rice and his serum.

This is a single case report, so it cannot show how often cereulide causes such severe illness or which treatments were decisive. It does show that a food-borne toxin can mimic fulminant liver failure in a previously healthy person.