Man in his 20s develops multi-organ failure after reheating room-temperature rice, liver transplant considered

A man in his 20s developed multiple organ failure after reheating and eating rice that had been left out at room temperature, according to a newly published case report.

His condition deteriorated to the point where an emergency liver transplant was considered, but he ultimately recovered through intensive care without one. The cause was identified as severe cereulide poisoning.

Researchers at Erasmus MC Rotterdam university hospital in the Netherlands published the case Sunday in the international journal BMJ Case Reports.

According to the paper, the man, who had no significant medical history, cooked a rice dish on Sunday and left it in the kitchen overnight, then reheated and ate it the following day. The kitchen temperature at the time exceeded 30 degrees Celsius.

Feeling unwell after the meal, he went to bed early, only to be found unconscious in bed the next morning. By the time he was taken to hospital, he was experiencing generalized seizures and severe hypoglycemia.

Hospital tests confirmed acute liver failure with hyperammonemia, acute kidney failure and lactic acidosis. His condition deteriorated so rapidly that doctors evaluated the need for an emergency liver transplant.

He gradually improved with intensive treatment, including glucose administration, ammonia and glutamine scavengers, and continuous venovenous hemodialysis. By the fourth day of hospitalization he was removed from the liver transplant waiting list, and he was discharged after 14 days with neurological function restored.

After completing a rehabilitation program, he returned to work. A mild tremor in his hands was reported, but he had no other notable symptoms.

Toxicological analysis detected high concentrations of cereulide — a toxin produced by the bacterium Bacillus cereus, which causes food poisoning — in the food he had consumed.

Cereulide is a heat-stable toxin that is not destroyed by cooking or boiling, even at temperatures above 100 degrees Celsius. Ingestion can cause vomiting, nausea and abdominal pain, and in severe cases it can lead to liver damage and serious complications.

The researchers suggested that the man's failure to vomit after eating may have increased the systemic absorption of the toxin. His brother, who ate the same food, recovered within two days after vomiting and experiencing diarrhea.

"The patient experienced abdominal cramps and malaise but did not vomit and went to sleep," the researchers said. "This may have allowed greater systemic absorption of the toxin than in his brother, who vomited after ingestion."

The researchers said symptoms appeared within hours of the meal, and liquid chromatography-tandem mass spectrometry analysis detected very high concentrations of cereulide in gastric contents remaining in the body.

The team said the case highlights the dangers of cereulide poisoning linked to improperly stored starchy foods such as rice, and urged the public to follow food safety guidelines — including handling cooked food safely and refrigerating it promptly.