Fatal poisoning by accidental ingestion of the “heartbreak grass” (Gelsemium elegans) verified by toxicological and medico-legal analyses

We present a case of fatal poisoning from accidental ingestion of Gelsemium elegans ( G. elegans ), a rarely toxic plant. A 41-year-old man was found dead, at his home, 6 h after drinking homemade herbal liqueur during lunch. Autopsy and routine toxicological analyses identified neither significant pathological findings nor routine poisons. However, a local botanist revealed that the homemade herbal liqueur contained G. elegans , a poisonous plant specific to Asia. To ascertain whether the decedent had ingested G. elegans , we performed liquid chromatography-mass spectrometry (LC-MS) and found two alkaloids (gelsemine and koumine) in his blood, gastric contents, as well as the suspected herbal liqueur. The cause of death was therefore confirmed to be G. elegans poisoning. Case reports of fatal poisoning due to ingestion of G. elegans are quite rare in English. Therefore, the present case broadens the scope on the possibility of death due to ingestion of G. elegans for forensic pathologists and toxicologists.