A man in his 20s developed acute liver failure and kidney damage severe enough that doctors considered a liver transplant after he reheated and ate a rice dish prepared the previous day, according to a published case report.
The report, titled "Fulminant multi-organ failure associated with cereulide-producing Bacillus cereus after ingestion of improperly stored rice," was published recently in BMJ Case Reports by researchers at Erasmus MC University Medical Center Rotterdam in the Netherlands.
According to the paper, the man, who had no notable medical history, left a cooked rice dish on his kitchen counter overnight instead of refrigerating it. The kitchen temperature at the time was reported to have exceeded 30 degrees Celsius.
He reheated and ate the dish the next day. He went to bed early after feeling unwell and was found unconscious the following morning.
When he arrived at the hospital, he was having generalized seizures and showed severe hypoglycemia. Tests showed rapidly deteriorating liver function and elevated blood ammonia levels, followed by evidence of kidney damage.
As his condition worsened quickly, doctors transferred him to a facility capable of performing transplants, with an emergency liver transplant under consideration. The paper said the patient progressed through acute liver failure, acute kidney injury and lactic acidosis to multi-organ failure, requiring evaluation for an emergency liver transplant.
The cause was traced to the food he had eaten. Analysis of the leftover rice dish and the patient's blood detected high concentrations of cereulide, a toxin produced by Bacillus cereus.
A sibling who ate the same food also had vomiting and diarrhea but recovered within two days. The man, by contrast, deteriorated sharply without the vomiting or diarrhea commonly seen in food poisoning.
Bacillus cereus is widely present in soil and other natural environments and can cause food poisoning in starchy foods such as rice and pasta.
The particular concern is cereulide, which causes the vomiting type of food poisoning. The toxin is heat-stable, meaning that once it has formed in food, reheating may not sufficiently remove it. Bacillus cereus spores can also survive ordinary cooking, so if cooked food is not kept at an appropriate temperature, the bacteria can multiply and produce the toxin.
Doctors gave the patient glucose and managed the metabolic abnormalities caused by the toxin while providing intensive care that included dialysis and support for breathing and blood pressure.
His liver function began to recover on the third day of hospitalization, and he was removed from the liver transplant waiting list on the fourth day. His kidney function also improved, and he was discharged, returning to daily life after rehabilitation. The paper said the patient ultimately avoided a liver transplant and recovered fully, including neurologically.
Bacillus cereus food poisoning linked to rice usually ends with relatively mild symptoms such as vomiting or diarrhea, but in rare cases it can lead to life-threatening conditions such as acute liver failure or kidney damage.
In an Austrian case published in 2022, five adults who ate fried rice contaminated with Bacillus cereus showed symptoms of food poisoning, and one of them suffered life-threatening acute liver failure and acute kidney injury.
