Abstract: Background: Mandragora officinarum is a Mediterranean plant belonging to the Solanaceae family and contains tropane alkaloids—primarily atropine, hyoscyamine, and scopolamine—responsible for anticholinergic toxicity. While most reported cases are self-limited, severe and fatal outcomes remain uncommon, particularly in pediatric populations. Hepatic failure is not typically considered a dominant feature of mandragora intoxication. Case Presentation: We report a fatal pediatric case following suspected ingestion of Mandragora officinarum. The child developed rapid neurological deterioration with seizures, profound hypoglycemia, and severe metabolic instability. Laboratory investigations revealed massive hepatocellular cytolysis and marked coagulopathy, consistent with acute liver failure. Toxicological analysis identified tropane alkaloids in biological samples. Complete medico-legal autopsy excluded traumatic, infectious, or structural causes of death. Results and Interpretation: The clinical evolution, biological findings, toxicological confirmation, and absence of alternative etiologies support fatal tropane alkaloid intoxication complicated by fulminant hepatic failure and multiorgan dysfunction. The severity of liver involvement markedly exceeds the mild and reversible hepatic abnormalities typically described in mandragora poisoning. Conclusion: This case highlights the potential for atypical and life-threatening systemic involvement in pediatric tropane alkaloid intoxication. It underscores the importance of integrated clinico-toxicological and forensic assessment in establishing medico-legal causality, particularly in settings where quantitative toxicological analysis is unavailable.

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