Sir, plants have been used through the ages to treat illness. For example, chewing willow bark to relieve headaches was prescribed as long ago as 400 BC by Hippocrates. Some plants, such as monkshood (Aconitum napellus) and foxglove (Digitalis lanata), are extremely toxic, yet at the right dose still have medicinal uses. Irritant plants can lead to dramatic effects if consumed. Stinging nettles (Urtica dioica), for example, need to be properly prepared for them to be edible.

Cuckoo pint (Arum maculatum) is highly irritating to oral/oesophageal mucosa and, if ingested, can cause swelling of the tongue and throat, leading to difficulty swallowing and breathing. In North Lancashire/South Cumbria, two cases of mistaken identity between the cuckoo pint and wild garlic have led patients to seek medical attention in the last year.

The first case involved a 54-year-old male who, whilst out walking in the countryside in early January, sampled what he thought was 'wild garlic'. Intense burning pain forced him to spit out the stalk immediately and blisters formed on his lips which lasted for some two weeks. Fortunately, this patient had tested it on his lip before attempting to put it into his mouth thus avoiding more severe consequences. Details of this case were shared with colleagues at the local maxillofacial unit so, when a second case occurred a few weeks later, diagnosis was straightforward.

The second patient presented for emergency treatment at Furness General Hospital having eaten a curry made from 'wild garlic'. In this case, severe burning pain in the oesophagus was experienced. It was quickly established that she too had mistaken cuckoo pint for wild garlic.

During January and February, in this part of the country, both cuckoo pint and wild garlic have glossy green foliage which grows on short stalks. By April, the two plants look completely different and the risk of mistaken identity is much reduced. We hope that publication of our letter at this time of year may help colleagues should further patients present with similar symptoms over the next few months.

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