A Rare Case of Intravenous Pesticide Poisoning with Upper Extremity Necrosis

Abstract

Intentional pesticide poisoning is not uncommonly encountered in emergency care settings, and the route of administration is generally oral. We present a peculiar case of intravenous pesticide injection and the prolonged management of upper extremity necrosis that ensued. A man who had injected an unidentified pesticide into his antecubital vein was admitted for acute renal failure and left arm cellulitis. After vital status stabilization, the patient was referred for cellulitis management. A febrile inflammatory draining wound was centered on the antecubital fossa. Incisional drainage and fasciotomy revealed thick pesticide-smelling mucoserous fluid and liquifaction necrosis following the course of thrombosed and sclerotic vessels. Serial surgical debridement and negative pressure wound therapy allowed local skin flap coverage. However, a large post-discharge seroma developed and the patient was re-admitted for nearly a month of additional wound management which finally achieved successful recovery with full range of motion of the arm and hand. Intravenously injected pesticide is poorly cleared by local tissues and can cause abscess formation and liquifactory necrosis. Recognition of the poisoning agent and early initiation of fasciotomy and serial debridement is necessary for successful wound management of the involved extremity.

Agricultural Pesticide Injection into the Rectus Abdominis Muscle: A Case Report

“…When chlorinated hydrocarbon pesticides are injected intravenously, they can cause tissue damage in the form of necrotizing fasciitis, which progresses by dissolving the lipid-rich membranes of the microvasculature in the human body [10]. In contrast, it is not known in detail what kind of tissue damage anthranilic diamide pesticides (including cyantraniliprole) cause when injected intravenously or intramuscularly in the human body.…”