Fueled by social media, food challenges have become a trendy new fad, that in some cases, can go from fun to fatal very quickly. The Cinnamon Challenge is one example of this, where young adults posted YouTube videos of themselves swallowing a tablespoon of ground cinnamon in 60 seconds without drinking, leading to numerous calls to Poison Control Centers. In this case, published in the Journal of Emergency Medicine, a food challenge with ghost peppers leads to a potentially life-threatening situation that could have easily been misinterpreted as indigestion after a spicy meal.

The patient, a 47-year-old male, presented with severe abdominal and chest pain subsequent to violent retching and vomiting. Before arriving at the ER, the patient had been at a restaurant where he consumed a hamburger that included ghost pepper puree as part of a food challenge; following ingestion he began to experience severe pain and burning in his mouth. Ghost peppers are considered the hottest chili peppers in the world with a measured ‘heat” of >1,000,000 Scoville heat units. After ingesting this meal, forceful retching and vomiting followed at which point the patient started to feel severe chest pain and abdominal pain.

Examination revealed the following:

  • Epigastric tenderness to palpitation
  • Blood pressure: 174/106mmHg
  • Heart rate: 106 beats/min
  • Respiratory rate: 18 breaths/min
  • Oxygen saturation: 96% on room air
  • Temperature: 36.3 Cº
  • White blood cell count: 15.7 x 103/µL
  • Hemoglobin: 15.1g/dL
  • Hematocrit: 43.4%
  • Platelet count: 221 x 109/L
  • Creatinine: 1.14mg/dL
  • Liver function tests: normal 

To help with the patient’s discomfort, he was given a “GI cocktail” that included viscous lidocaine and liquid Maalox, as well as pantoprazole IV and hydromorphone.  While initial review of the chest X-ray by the ER physician was negative, a review by the radiologist showed “evidence of subcutaneous emphysema, a subtle left apical pneumothorax, poor aeration of the base of the left lung, and suspected pneumomediastinum.”