The nature and epidemiology of plant intoxications are still not well understood, with recent data being limited. The present study aims to report cases of plant poisoning in the clinical practice of the Clinical Toxicology Department at the Naval Hospital—Varna, Bulgaria, over a 20-year period (2003–2023). A documentary retrospective analysis of the hospitalized cases of poisoning with poisonous plants and their grouping into toxidromes was performed. During the study period, patients with plant poisoning admitted to our hospital unit accounted for 0.35% of a total of 12,857 hospitalized individuals. The distribution across the toxidromes based on clinical presentation revealed the highest frequency of anticholinergic, cyanogen, and ricin toxidromes. The majority of the intoxications resulted from unintentional exposure to plant toxins in adult individuals. Most cases followed a mild to severe clinical course, with patient discharge occurring between 2 and 5 days. No fatalities were recorded, thanks to the reported treatment methods. A relatively low incidence of plant-related poisonings was observed, with their predominant manifestations affecting the gastrointestinal, nervous, and cardiovascular systems. Increased reporting of epidemiological data and clinical experiences in the management of plant intoxications would substantially enhance researchers’ understanding of them and facilitate the development of a standardized treatment protocol.

All parts of Alocasia × amazonica (A. amazonica, Araceae) pose a toxicological risk due to oxalate production. Ingestion of the plant extract may cause multi-organ damage and fatal outcomes. Given the rarity of poisoning cases, its toxicological profile and systemic effects remain insufficiently characterized. This study aimed to investigate and report an appropriate approach to managing a patient intoxicated with A. amazonica (Araceae). A case of intentional self-poisoning with A. amazonica is presented. The patient, a 63-year-old woman, ingested approximately 200–300 mL of liquid prepared from the grated root of the plant. The initial clinical presentation involved localized injuries to the oral cavity and gastrointestinal tract, including severe pain, hoarseness, aphonia, dysphagia, mucosal erosions, and necrosis. Additional symptoms included hematinic vomiting, hemorrhagic diarrhea, and abdominal discomfort. These superficial and mucosal lesions resolved without the development of adhesions. Systemic effects comprised impaired consciousness indicative of encephalopathy, early metabolic acidosis, pulmonary edema with acute respiratory insufficiency, mild liver dysfunction, and hematuria. The therapeutic protocol for oral poisoning management was appropriate, leading to the patient’s discharge after 20 days of hospitalization.

Background: Clear cell renal cell carcinoma (ccRCC) constitutes 75–80% of all renal cell carcinomas and exhibits aggressive behavior with high metastatic potential. Common metastatic sites include lungs, bones, lymph nodes, and liver, while urinary bladder involvement is exceedingly rare. Early detection of atypical metastases is critical for risk stratification, surgical planning, and systemic therapy selection. Methods: We report a 69-year-old male presenting with recurrent, painless gross hematuria and dysuria. Contrast-enhanced computed tomography revealed a left renal mass with bilateral pulmonary nodules, regional lymphadenopathy, and a bladder lesion. The patient underwent transurethral resection (TUR) of the bladder lesion, followed by robot-assisted left nephro-adrenalectomy with para-aortic lymphadenectomy. Histopathology and immunohistochemistry (PAX8+, CD10+, CAIX+, CK7−, GATA3−) confirmed ccRCC with synchronous bladder metastasis. Postoperatively, combined immune checkpoint inhibitor (ICI) therapy and tyrosine kinase inhibitors (TKIs) were initiated. Results: TUR provided symptomatic relief and diagnostic confirmation. Robot-assisted surgery enabled precise, oncologically safe excision of the primary tumor and regional metastases with minimal blood loss and no perioperative complications. Pathological staging was pT3aN1M1, ISUP grade 2, with lymphovascular invasion, confirming advanced disease requiring systemic therapy. Early initiation of ICI plus TKI therapy targeted residual micrometastases to potentially prolong survival. Conclusions: This case highlights the rare occurrence of ccRCC with synchronous bladder metastasis and underscores the importance of comprehensive imaging, detailed morphologic and immunohistochemical evaluation, and a multidisciplinary approach. Robot-assisted cytoreductive surgery combined with modern systemic therapy represents an effective strategy for advanced ccRCC, emphasizing the need for individualized treatment and long-term follow-up in atypical metastatic scenarios.

Caffeine is widely consumed and generally considered safe at customary doses. How-ever, high-dose preparations available online pose a risk of severe and potentially fatal intoxication. Although uncommon, lethal caffeine poisoning is associated with profound cardiovascular and neurological toxicity. A rare case of intentional acute caffeine intoxication with fatal outcome is presented. A 25-year-old woman ingested an estimated 60 tablets containing 200 mg of caffeine each, purchased online. She was admitted to hospital shortly after ingestion of the caffeine tablets with palpitations, agitation, dizziness, and repeated vomiting. On examination, she presented with arterial hypotension (90/60 mmHg) and marked sinus tachycardia (150 beats/min), accompanied by psychomotor agitation. Her blood caffeine concentration measured by means of high-performance liquid chromatography (HPLC) was 177 µg/mL. The patient’s condition rapidly deteriorated, with the development of convulsive syndrome progressing to coma, extreme ventricular tachycardia, exotoxic shock, and toxic cardiomyopathy. Despite intensive care management, including mechanical ventilation and advanced cardiopulmonary resuscitation, the patient died several hours after admission. In conclusion, this case underscores the life-threatening potential of acute high-dose caffeine ingestion and highlights the risk associated with unrestricted access to concentrated caffeine products. Early recognition and aggressive management are crucial, yet may be insufficient in cases of massive overdose.

Polysubstance use, particularly the combination of opioids with stimulants such as cocaine and methamphetamine, is increasingly prevalent and contributes to severe morbidity and mortality. It results in complex clinical consequences, with an expanded spectrum of complications and reduced efficacy of standard emergency interventions. Co-occurring psychiatric disorders and under-recognized systemic injuries beyond primary target organs further complicate patient assessment and management. We report a clinical case of a 37-year-old male with chronic Hepatitis C Virus in-fection and documented polysubstance abuse, including fentanyl, cocaine, metham-phetamine, and cannabis, resulting in fatal complications. The patient developed mas-sive rhabdomyolysis, acute kidney injury with anuria, generalized edema, and left-sided deep vein thrombosis. The clinical course demonstrated rapid progression of multisystem dysfunction, severe electrolyte disturbances, and high-risk metabolic de-rangements. Management included intensive intravenous hydration, diuretic therapy, urinary alkalinization, electrolyte correction, anticoagulation, hemodialysis, and com-prehensive supportive care. This case illustrates the complex pathophysiology of polysubstance toxicity, in which additive and potentially synergistic interactions exacerbate organ damage. Acute rhabdomyolysis emerged as a central mechanism, driven by both sympathomi-metic-induced hypermetabolism and opioid-related immobilization, ultimately precip-itating fatal renal and systemic complications. Despite intensive medical interventions, including hemodialysis, and active family support, the patient’s refusal to continue treatment proved a critical determinant of the fatal outcome. The case underscores the urgent need for effective strategies to manage patients with substance use disorders in acutely life-threatening conditions. It raises the importance of early psychiatric in-volvement, assessment of decision-making capacity, and, where legally justified, tem-porary measures to prevent self-harm resulting from treatment refusal.

Background: Ewing sarcoma is a rare but aggressive malignant tumor that primarily affects adolescents and young adults. Although it typically arises in bone, in rare cases it may originate in parenchymal organs such as the kidney. Case Presentation: We present a 45-year-old woman with a history of breast carcinoma and a right renal mass. Imaging revealed a multicystic lesion with septations and nodular thickening. Histology and immunohistochemistry were consistent with extraskeletal Ewing sarcoma; FISH confirmed the characteristic rearrangement (t(11;22)(q24;q12)/EWSR1-ETS). The patient underwent nephrectomy followed by VDC/IE chemotherapy. Given her oncologic history and age, Li-Fraumeni syndrome was considered. Conclusions: This case highlights a rare primary renal localization of Ewing sarcoma and underscores the value of a multidisciplinary approach with molecular confirmation to secure diagnosis and guide therapy.