Abstract
Background
Acute organophosphate (OP) toxicity causes a wide range of clinical effects on the
respiratory system, including pulmonary bronchoconstriction and bronchorrhea. Morbidity
and mortality from acute OP toxicity correlate best with pulmonary secretions.
Objective
In this article, we report bilateral loculated pleural effusion as a rare pulmonary
effect in a patient with acute parenteral OP toxicity.
Case Report
A 25-year-old, previously healthy woman was transferred to our Poison Department 3
days after suicidal injection of malathion. At the time of presentation her vital
signs were normal, except that her respiratory rate was 24 breaths/min. She complained
of pleuritic chest pain and had a cough productive of yellow sputum. She had generalized
chest wall tenderness, and breath sounds were decreased in the base of both lung fields.
Standard therapy for OP toxicity, including atropine, pralidoxime, and diazepam, was
initiated. Due to persistent pleuritic chest pain, a computed tomography (CT) scan
was performed that showed bilateral loculated pleural effusions. Shortly after hospital
admission, the patient developed respiratory distress, for which she was intubated
and transferred to the Intensive Care Unit. She received continued medical therapy
and was extubated on hospital day 3. A CT scan of the chest on hospital day 9, after
completion of the treatment, documented resolution of the effusions.
Conclusion
Parenteral OP toxicity occurs rarely, and in this case it was associated with bilateral
loculated pleural effusions. In this regard, it should be considered in a patient
with acute parenteral OP toxicity and persistent chest wall pain.
Keywords
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Article info
Publication history
Published online: December 27, 2010
Accepted:
November 3,
2010
Received in revised form:
June 8,
2010
Received:
February 4,
2010
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
