New insights into the organophosphate-induced intermediate syndrome

Abstract

Acute organophosphate (OP) poisoning can be deadlier than any other type of chemical poisoning. So far, only a few cases have been described that include extensive neurological complications. We present an outstanding case of severe oral OP poisoning with intermediate syndrome developed on the fourth day after hospital admission. The clinical picture involved weakness of the proximal upper and lower limb muscles and several muscles supplied by motor cranial nerves, but, what is peculiar, the distal upper and lower limb muscles were also affected (forearms, hands, legs, and feet). To our knowledge, this is a unique presentation, as lower limb muscle weakness was reported only in the context of delayed polyneuropathy. Another remarkable feature was the involvement of six of the twelve cranial nerves, which makes this case of intermediate syndrome the first with such a spread of muscle weakness and provides new insights into the polymorphic clinical manifestations of acute OP poisoning.

Toxicity in Peripheral Nerves: An Overview

“…Some substances, such as tri-chloro-ethilene (TCE), have a bi- or tri-modal course of action, which is an acute or subacute toxicity or an intermediate toxicity followed by a late toxicity, with different clinical patterns [ 23 ]. As an example, organophosphate intoxications can induce a cholinergic syndrome, such as the acute effect resulting in weakness of neck extensors, proximal muscles (including ventilatory muscles) and cranial nerves [ 24 ]. An intermediate effect as well as a late effect are represented in the organophosphate-induced delayed polyneuropathy, resulting in sensory symptoms, sensorimotor neuropathy and ataxia.…”

Duodenal perforation after organophosphorus poisoning: A case report

“…In the vast southwestern regions of China, pesticide use and storage are poorly managed, and thus, people sometimes commit suicide by oral administration of pesticides. Patients with severe OP usually have disturbance of consciousness, respiratory failure, toxic shock, and gastrointestinal dysfunction[ 1 ]. However, concurrent duodenal perforation has not been reported in the literature.…”