Calcified pericarditis is a rare occurrence, most commonly seen with constrictive pericarditis. Our patient was a rare case where the presentation was a seizure, with the rare complication of refractory prolonged corrected QT interval (QTc) ventricular tachycardia, which was appropriately managed. The diagnosis of calcific pericarditis arrived early, the patient stabilized in the intensive care unit (ICU) appropriately and underwent the definitive surgery on time to survive this fatal condition.

A 57-year-old gentleman with an alleged history of (h/o) consumption of approximately 50-100 mL of a pesticide (1:2 compound, containing bioemulsifier 6%; oligosaccharide, 8%; fillers/carriers, 86%) at his home presented within 2 hours to a private hospital where gastric lavage was done and referred for deteriorating conscious level. On arrival, 5 hours from the time of consumption, he was stuporous. Glasgow Coma Scale (GCS) was 7/15, had central cyanosis, SpO 2 -62% with severe hypotension, which responded to fluid. In view of poor GCS and low SpO 2 , he was ventilated. Post intubation SpO 2 -86% with 100% FiO 2 . His blood gas revealed normal saturations, and co-oximetry showed a methemoglobin level of 63.5%. In view of raised MetHb, he was administered 2 mg/kg of methylene blue and shifted to ICU. In the subsequent arterial blood gas, methemoglobin levels remained high. Further boluses of methylene blue were tried upto a cumulative dose of 7 mg/kg without consistent reduction of methemoglobin levels to normalcy. Glucose-6-phosphate dehydrogenase (G6PD) deficiency was ruled out. A hematologist consultation was obtained, and one cycle of plasmapheresis was attempted, but the level did not decrease. An exchange