Toxicity from secretions of Phyllomedusa bicolor (Kambo frog) with severe clinical presentation: case report

Abstract

The secretions of the Kambó frog (Phyllomedusa bicolor) have been ancestrally used in ceremonial rituals for therapeutic purposes and are currently considered part of the psychedelic substances group (Section modified to emphasize medical act/toxicity as per editorial recommendation). However, their use—which has expanded across various regions—entails significant risks, with limited documentation in the medical literature, particularly in Colombia. We report the case of a 49-year-old male foreign patient who developed a severe clinical condition following the application of Kambó frog secretions during a ritual in a rural municipality of Antioquia, Colombia. Approximately six hours after the ritual, he experienced nausea, repeated vomiting, a likely seizure, and signs of facial trauma.A crucial point to highlight is that the patient was initially assessed and managed in the emergency department under the suspicion of anaphylactic shock, without considering specific Kambó toxicity (Section rewritten to emphasize initial diagnostic confusion, as per recommendation). This initial diagnostic error underscores the importance of clinical suspicion in such cases. During his hospital course, the patient developed significant complications, including euvolemic hypoosmolar hyponatremia, rhabdomyolysis, metabolic acidosis, acute kidney injury, and hepatotoxicity—manifestations that required specialized management in the intensive care unit. He was treated with invasive ventilatory support, vasopressors for shock management, and N-acetylcysteine for hepatotoxicity.Later in his clinical course, pulmonary tuberculosis was diagnosed based on positive sputum smears; however, the patient signed a voluntary discharge form before initiating anti-tuberculosis treatment—an event that significantly influenced his clinical progression and outcome. This case highlights the serious risks associated with the use of Kambó frog secretions, including severe electrolyte disturbances, multi-organ involvement, and the diagnostic complexity when differentiating from other conditions such as anaphylactic shock. Increasing medical awareness of the potential toxicity of these substances in emergency settings is critical for timely and appropriate diagnosis and treatment. Furthermore, there is an urgent need to promote research that contributes to generating evidence-based knowledge and clear clinical guidelines for managing such intoxications.