• Andon Chibishev University Clinic for Toxicology and Urgent Internal Medicine, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republiic of North Macedonia


Keywords: atropa belladonna, parasympathetic block, anticholinergic syndrome


Atropa belladonna L., family Solanaceae, or also known as a deadly nightshade, is a plant which foliage and berries contain a high concentration of alkaloids and is extremely toxic. When these substances are being accidentally ingested, they tend to block the postganglionic parasympathetic fibers and muscarinic receptors in the central nervous system, thus causing an emergency clinical state known as anticholinergic toxic syndrome. In this article we present two cases of this rare clinical syndrome.


Southgate HJ, Egerton M, Dauncey EA. Lessons to be learned: a case study approach. Unseasonal severe poisoning of two adults by deadly nightside (Atropa belladonna). J R SocPromot Health 2000; 120(2): 127–30. doi: 10.1177/146642400012000212.

Mowry JB, Spyker DA, Cantilena LR Jr, McMillan N, Ford M. 2013 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 31st Annual Report. Clin Toxicol (Phila) 2014; 52(10): 1032-283. doi: 10.3109/15563650.2014.987397.

Joshi P, Wicks AC, Munshi SK. Recurrent autumnal psychosis. Postgrad Med J 2003; 79: 239–40.

Lan X., Zeng J.,Liu K., Zhang F., Bai G., Chen M., Liao Z., Huang L. Comparison of two hyoscyamine 6β-hydroxylases in engineering scopolamine biosynthesis in root cultures of Scopolia lurida. Biochem. Biophys. Res. Commun. 2018;497:25–31.

Caksen H, Odabaş D, Akbayram S, Cesur Y, Arslan S, Uner A, et al. Deadly nightshade (Atropa belladonna) intoxication: an analysis of 49 children. Hum Exp Toxicol 2003; 22(12): 665-8. doi: 10.1191/0960327103ht404oa.

Trabattoni G, Visintini D, Terzano GM, Lechi A. Accidental poisoning with deadly nightshade berries: a case report. Hum Toxicol 1984; 3(6): 513-6. doi: 10.1177/096032718400300607.

Zhao T, Li S, Wang J, Zhou Q, Yang C, Bai F, Lan X., Chen M, Liao Z. Engineering tropane alkaloid production based on metabolic characterization of ornithine decarboxylase in atropa belladonna. ACS Synth. Biol. 2020;9:437–448

Alizadeh A, Moshiri M, Alizadeh J, Balali-Mood M. Black henbane and its toxicity - a descriptive review. Avicenna J Phytomed 2014; 4(5): 297-311. PMID: 25386392; PMCID: PMC4224707.

Zeng L, Zhang Q, Jiang C, Zheng Y, Zuo Y, Qin J, et al. Development of Atropa belladonna L. Plants with High-Yield Hyoscyamine and without Its Derivatives Using the CRISPR/Cas9 System. Int J Mol Sci 2021; 22(4): 1731. doi: 10.3390/ijms22041731.

Cock I. The safe usage of herbal medicines: counter indications, cross-reactivity and toxicity. PharmacognCommun 2015; 5(1): 2-50. doi: 10.5530/pc.2015.1.2.

Vangoori Y, Janapati S. Evaluation of anti-inflammatory effect of Belladonna (a homeopathic drug) in experimental animals-rats. Int J Pharma Bio Sci 2013; 4(3): 111-115.

Glatstein M, Alabdulrazzaq F, Scolnik D. Belladonna Alkaloid Intoxication: The 10-Year Experience of a Large Tertiary Care Pediatric Hospital. Am J Ther 2016; 23(1): e74-7.

Lange A, Toft P. Poisoning with nightshade, Atropa belladonna. UgeskrLaeger 1990; 152:1096.

Karadaş S, Selvi Y, Mustafa Ş, Selvi F, Reşit Ö, Özgökçe F. DaturaStramoniumZehirlenmesi: PsikiyatrikBelirtilerleBaşvuranOlgu. Düşünen Adam PsikiyatriveNörolojikBilimlerDergisi. 2011;24:152–4.

Spina SP, Taddei A. Teenagers with Jimson weed (Daturastramonium) poisoning. Cjem 2007; 9: 467–8. doi: 10.1017/s1481803500015530.

Fatur K, Kreft S. Nixing the nightshades: Traditional knowledge of intoxicating members of the Solanaceae among hallucinogenic plant and mushroom users in Slovenia. PLoS One. 2021 Feb 22;16(2)

Maffè S, Paffoni P, Laura Colombo M, Davanzo F, Dellavesa P, Cucchi L, Zenone F, Paino AM, Franchetti Pardo N, Bergamasco L, Signorotti F, Parravicini U.G, Toxicology, Ital Cardiol (Rome). 2013 Jun;14(6):445-55.

Laffargue F, Oudot C, Constanty A, Bedu A, Ketterer-Martinon S. Deadly nightshade (Atropa belladonna) intoxication in a 2-year-old child. Arch Pediatr 2011; 18(2): 186–8. doi: 10.1016/j.arcped.2010.11.006.

Tulin F, Kirpinar I. Psychiatric Aspects of a Case with Deadly Nightshade Intoxication. Journal of academic emergency medicine 2011; 10(2): 86–88. doi: 10.4170/jaem.2009.96658.

Lee MR. Solanaceae IV: Atropa belladonna, deadly nightshade. J R Coll Physicians Edinb 2007; 37(1): 77–84.

Davies F, Gupta R. Apparent life threatening events ininfants presenting to an emergency department. EmergMed J 2002; 19: 11–16. doi: 10.1136/emj.19.1.11.

Chadwick A, Ash A, Day J, Borthwick M. Accidental overdose in the deep shade of night: a warning on the assumed safety of 'natural substances'. BMJ Case Rep 2015; 2015: bcr2015209333. doi: 10.1136/bcr-2015-209333.

Cikla U, Turkmen S, Karaca Y, Ayaz AF, Turedi S, Gunduz A. An Atropa belladonna L poisoning with acute subdural hematoma. Hum Exp Toxicol 2011; 30(12): 1998–2001. doi: 10.1177/0960327111407225.






Case Reports