We report a case of fulminant liver failure resulting in emergent liver 
transplantation following 3 weeks of nausea, vomiting, and malaise from Jamaican 
Vomiting Sickness. Jamaican Vomiting Sickness is caused by ingestion of the 
unripe arils of the Ackee fruit, its seeds and husks. It is characterized by 
acute gastrointestinal illness and hypoglycemia. In severe cases, central 
nervous system depression can occur. In previous studies, histologic sections 
taken from patients with Jamaican Vomiting Sickness have shown hepatotoxicity 
similar to that seen in Reye syndrome and/or acetaminophen toxicity. We 
highlight macroscopic and microscopic changes in the liver secondary to 
hepatoxicity of Ackee fruit versus those caused by a previously unknown sickle 
cell trait. We discuss the clinical variables and the synergistic hepatotoxic 
effect of Ackee fruit and ischemic injury from sickled red blood cells, causing 
massive hepatic necrosis in this patient.