Outbreaks of Hypoglycemic Encephalopathy in Muzaffarpur, India: Are These Caused by Toxins in Litchi Fruit?: The Point.

While they had failed to solve the mystery, we showed clearly that the disease is an encephalopathy, associated with hypoglycemia, hence metabolic, and not infectious [2]. We found strong epidemiological association of the disease with litchi fruit [2]. The manifestations are similar to hypoglycemic encephalopathy caused by methylene cyclopropylalanine (MCPA) present in ackee fruit; ackee and litchi belong to the same family, Sapindacae [2]. Litchi seed contains the analogue methylene cyclopropyl-glycine (MCPG) [2]. Both MCPA and MCPG induce hypoglycemic encephalopathy in experimental animals [2]. The striking spatial and temporal association with litchi harvesting indicated high probability that encephalopathy was triggered by MCPG. Yewale cited our paper but remained unconvinced that the diagnosis was metabolic encephalopathy, without stating the reason, and continued to call it a mystery [1,2].