We report the case of a 25-year-old male who presented to the Emergency Department (ED) with severe epigastric abdominal pain immediately after ingesting a freshly squeezed beverage form of Flying Dragon Hardy Orange plant (Poncirus trifoliata). Poisoncontrol was contacted and recommended symptomatic treatment only. The patient’s painresolved while in the emergency department. Seed and rind preparations have been used as an herbal remedy in East Asia. A number of research articles point to ongoing investigations into the antiinflammatory and possible antiviral properties of Poncirus species. Freshly squeezed Poncirus trifoliata can cause significant abdominal pain.

Plants can be a source of medicinals but can also be a source of adverse reactions and toxicity. The Flying Dragon Hardy Orange plant (Poncirus trifoliata) can cause severe abdominalpain when the fruit is freshly squeezed.Knowledge of the toxic effect of this plant can prevent a prolonged and complex work-up for abdominal pain.

Case Presentation:

A 25-year-old male presented to the ED with intense epigastric abdominal pain immediately after drinking freshly squuezed juice from oranges he had picked from a tree while on vacation in Florida. He brought the oranges home from vacationthe day after picking them. He found the stems and the oranges to be uniqueand kept severalstems as well as the orange fruits.His relatives in Florida told him that the tree was a Flying Dragon Hardy Orange.The tree was used by the relatives as a hedge.

In the ED, he was noted in good health with no significant past medical history. He had no nausea, vomiting or diarrhea. Vital signs were withinnormal limits. His physical exam including his abdominal exam was unremarkable. Basic lab work including a complete blood count, a basic metabolic panel and lipase were within normal limits. Poison control was contacted and recommended symptomatic treatment only. The pain resolvedcompletely within 60 minutesof arrival.

The patient was discharged. At 48 hour follow up by phone, the patient was well with no further symptoms.

The trifoliateorange (Poncirus trifoliata) is a deciduousthorny shrub with trifoliate leaves.There has been botanical debate concerning whethertrifoliate oranges shouldbelong to their own genus (Poncirus) or should belong the the Citrusgenus. The plantis nature to Northern Chinaand Korea. It is also known as the hardyorange because it is cold-hardy and can toleratemoderate frost and even snow. Poncirus species can be used as hedges.A variety with curved long thorns is known as the Flying Dragon variety. [1] The fruit is smaller than an orange and has a high concentration of seeds.

Seed and rind preparations have been used as an herbal remedy in East Asia. However,freshly squeezed Poncirus trifoliata can cause significant abdominal pain.

Prolonged skin contact can also cause skin irritation The North Carolina extension site classifies Poncirusspecies as poisonousbut with "lowtoxicity when eaten, skin irritation minor and lasting only for a few minutes. Severe stomach pain and nausea." [1]

However, the fruit rind of Poncirus can safely be made into jams and jellies.[2]

The ground rind and ground seeds have been used in traditional Chinese medicine to treat eczema as well as other conditions. [3-4]

A number of research articlespoint to ongoinginvestigation into the antiinflammatory and possible antiviralproperties of Poncirusspecies. [5-8]

We report the case of a 25-year-old male who presented to the ED with severe epigastric abdominal pain after ingestinga freshly squeezedbeverage form of Flying Dragon hardy orange (Poncirus trifoliata). Poison control was contacted and recommended symptomatic treatment only.

The patient’s pain resolved while in the emergency department. Freshly squeezed Poncirus trifoliata can cause severe abdominal pain. Knowledge of the toxic effect of this plant can prevent a prolonged and complex work- up for abdominal pain.

The authors declarethat they have no conflicts of interest.