“Never eat fried rice left at room temperature” ... A ‘deadly’ warning after a man nearly needed a liver transplant: Why? [Health Talk]

[Financial News] A case has been reported in which a man in his 20s who reheated and ate cooked rice that had been stored at room temperature developed multiple organ failure and came close to needing a liver transplant.

Researchers at Erasmus MC, University Medical Center Rotterdam, in the Netherlands, published the case in the international journal BMJ Case Reports on the 5th.
According to the paper, A, a previously healthy man in his 20s, left a rice dish cooked the day before on the kitchen counter overnight and reheated and ate it the next day. The kitchen temperature was above 30°C at the time. After feeling unwell following the meal, A went to bed earlier than usual. The next morning, he was found unconscious and taken to hospital.
When A arrived at the hospital, he was experiencing convulsions throughout his body and severe hypoglycemia. Tests showed that his liver function had deteriorated rapidly and that his kidneys had also been damaged as his blood ammonia levels rose. The medical team determined that he might need a liver transplant and transferred him to a hospital capable of performing the surgery.
A gradually improved after intensive treatment, including glucose, ammonia- and glutamine-removing agents, and continuous venovenous hemodialysis (CVVHD). He was removed from the liver transplant waiting list on the fourth day of his hospitalization, and his neurological function recovered. He was discharged 14 days after admission.
The man returned to work after undergoing a rehabilitation program. He was reported to have a slight tremor in his hand but no other notable symptoms.

Tests of the food A had eaten and left over, as well as his blood, detected high levels of cereulide, a toxin produced by the bacterium Bacillus cereus.
Cereulide is a heat-resistant toxin that is not destroyed by cooking or boiling, even at temperatures above 100°C. When ingested, it can cause vomiting, nausea and abdominal pain; in severe cases, it can lead to liver damage or serious complications.
The researchers believed that A’s failure to vomit after eating may have increased the amount of toxin absorbed systemically. His older brother, who ate the same food, reportedly recovered within two days after vomiting and experiencing diarrhea.
The researchers explained, “The patient experienced abdominal cramps and malaise but lay down and fell asleep without vomiting,” adding, “This may have allowed more of the toxin to be absorbed systemically than in the patient’s older brother, who vomited after eating.”
The researchers said the symptoms appeared within a few hours of the meal and that liquid chromatography–tandem mass spectrometry (LC-MS/MS) analysis detected a very high concentration of cereulide in food that remained in the body.
The researchers emphasized that this case highlights the risk of cereulide poisoning associated with starchy foods such as improperly stored rice, and that food safety practices should be followed, including handling cooked food safely and keeping it refrigerated.
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