Chlorpyrifos-Induced Delayed Neurotoxicity with A Rare Presentation of Flaccid Quadriplegia: A Diagnostic Challenge

  • Patrícia Afonso Mendes Internal Medicine Department A, Centro Hospitalar e Universitário de Coimbra, Coimbra http://orcid.org/0000-0003-0014-965X
  • Tatiana Cunha Pereira Oncology Service, Instituto Português de Oncologia de Coimbra Francisco Gentil, Coimbra
  • Rui Pina Internal Medicine Department A, Centro Hospitalar e Universitário de Coimbra, Coimbra
  • Rui Marques Santos Internal Medicine Department A, Centro Hospitalar e Universitário de Coimbra, Coimbra

Abstract

Chlorpyrifos is an organophosphate compound recognized as causing acute toxicity. However, organophosphate-induced delayed polyneuropathy (OPIDP), although rare, has also been described. We describe an unusual presentation of OPIDP with flaccid quadriplegia progressing to a locked-in-like syndrome, 30 days after a 60-year-old man voluntarily ingested chlorpyrifos. In the absence of specific treatment, the patient only recovered partial motor responses and the ability to communicate. The authors present this report in order to highlight a form of OPIDP which can hinder diagnosis due to its atypia and the delay in the onset of symptoms from initial contact with the toxicant.

References

  • Lotti M, Moretto A. Organophosphate-induced delayed polyneuropathy. Toxicol Rev 2005;24:37–49.

  • Vale A, Lotti M. Organophosphorus and carbamate insecticide poisoning.Handb Clin Neurol 2015;131:149–168.

  • Thivakaran T, Gamage R, Gunarathne KS, Gooneratne IK. Chlorpyrifos-induced delayed myelopathy and pure motor neuropathy: a case report. Neurologist 2012;18:226–228.

  • Jokanovic M, Stukalov PV, Kosanovic M. Organophosphate induced delayed polyneuropathy. Current Drug Targets CNS Neurol Disord 2002;1:593–602.

  • Merwin SJ, Obis T, Nunez Y, Re DB. Organophosphate neurotoxicity to the voluntary motor system on the trail of environment-caused amyotrophic lateral sclerosis: the known, the misknown, and the unknown. Arch Toxicol 2017;91:1–14.
  • Published: 2017-10-30

    Issue: Vol 5 No 1 (view)

    Section: Articles

    How to cite:
    Mendes, P., Pereira, T., Pina, R., & Santos, R. (2017). Chlorpyrifos-Induced Delayed Neurotoxicity with A Rare Presentation of Flaccid Quadriplegia: A Diagnostic Challenge. European Journal of Case Reports in Internal Medicine, 5(1). https://doi.org/https://doi.org/10.12890/2017_000751