Case Report: Organophosphorus Section Poisoning-Induced Intermediate Extrapyramidal Syndrome

Abstract

Organophosphate (OP) compounds are one of the most common agents used for deliberate self-harm in developing countries, including India. OP compounds inhibit the enzyme acetylcholinesterase, which is responsible for hydrolysing the neurotransmitter acetylcholine in both the central and peripheral nervous systems (PNS). Acute cholinergic crises are the most common clinical presentation of OP poisoning. While physicians mostly encounter acute and delayed complications, there have been rare documented cases in the litreature of an intermediate syndrome presenting with extrapyramidal symptoms such as tremors, rigidity, and dystonia. In this report, the authors present a case of a 64-year-old male patient who presented to the Emergency Department (ED) with a history of consuming an unknown quantity of OP-Phorate (11.2%). The initial manifestations included vomiting, sweating, difficulty in breathing, and a low level of consciousness. The patient was managed with atropine, pralidoxime, and mechanical ventilation. He was extubated but later reintubated due to respiratory failure. Eventually, a neurological examination revealed rigidity in all four limbs. The patient was diagnosed with an extrapyramidal type of intermediate syndrome and treated with oral amantadine and trihexyphenidyl. After further hospital monitoring, the patient was extubated and discharged with intact neurological function.

Keywords

• acute pesticide poisoning
• atropine
• extrapyramidal signs
• suicide