Severe uvular edema and nasal mucosal necrosis due to Ecbalium elaterium (squirting cucumber): An allergic reaction or direct toxic effect?

Ecbalium elaterium or squirting cucumber is a plant growing in the Mediterranean region, belong to Cucurbitaceae family. Its juice has been used as an herbal medicine since ancient times because of its cathartic and anti-inflammatory effects. It has been reported to cause upper airway edema, especially after the administration of its undiluted form. It has generally been attributed to allergic reaction. In this case report we aimed to interrogate this anticipation by presenting a case of severe uvular edema and nasal mucosal necrosis after dripping undiluted Ecbalium elaterium juice that did not improved by anti-allergic therapies.