The unexpected impersonator: A rare case of pretilachlor herbicide poisoning

Abstract

Pretilachlor is an extensively used herbicide worldwide that mimics the clinical presentation of Organophosphorus (OP) poisoning upon ingestion. Misdiagnosis can be a major setback and lead to inappropriate patient management. In this report, we discuss the case of a young man who presented with an alleged history of consumption of an unknown chemical compound, which was later confirmed to be pretilachlor. He had multiple episodes of emesis since the event, and the only systemic abnormality was a low heart rate of approximately 50 beats/min. Other cholinergic symptoms were absent, and atropine was administered after initial resuscitation and stabilization, with suspected OP poisoning as the top differential diagnosis. All laboratory findings, including pseudocholinesterase, were normal, which was unlikely to happen in the case of OP poisoning. Later, the consumption of the chemical pretilachlor, by the patient was confirmed. The patient was weaned off atropine and managed by systemic support and symptomatic treatment. He fully recovered within 4–5 days and was discharged in a stable condition with no risk of post-discharge complications.

Keywords

• pretilachlor
• organophosphorus poisoning
• chemical toxicology