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Of little yellow men and a fear of the light

Kushal Naha1, G Vivek, Ranjan K Shetty

  • 1Department of Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.

BMJ Case Reports
|August 16, 2013
PubMed

Insights

Digitalis toxicity from digoxin can cause visual disturbances, including seeing yellow figures, and photophobia. Discontinuing digoxin resolved these symptoms in a patient with atrial septal defect.

Area of Science:

  • Cardiology
  • Clinical Toxicology

Background:

  • A 65-year-old woman with atrial septal defect and paroxysmal supraventricular tachycardia was treated with digoxin and diuretics.
  • She presented with recurrent vomiting, severe pulmonary hypertension, and complete heart block.

Observation:

  • Clinical examination and transthoracic echocardiography confirmed an atrial septal defect with Eisenmengerization.
  • Electrocardiography revealed ST-segment changes indicative of digitalis toxicity.
  • The patient developed photophobia and visual hallucinations, describing doctors as 'little yellow men'.

Findings:

  • Serum digoxin levels were significantly elevated.
  • Cessation of digoxin therapy resulted in the gradual resolution of her symptoms, including visual disturbances and photophobia.

Implications:

  • This case highlights the importance of considering digitalis toxicity in patients with elevated digoxin levels presenting with neurological and visual symptoms.
  • It underscores the need for careful monitoring of digoxin levels and potential toxicity in patients with underlying cardiac conditions.
  • Recognizing these specific visual disturbances can aid in the early diagnosis and management of digoxin toxicity.

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