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Acute peripheral polyneuropathy with multiorgan failure: a diagnostic dilemma
Kosar Hussain1, Jawed Abubaker2, Javeed Ahmad Dar3
1Department of Internal Medicine, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
BMJ Case Reports
|June 6, 2014
Summary
This case report details a young man with severe abdominal pain, vomiting, and neuropathy. Elevated aluminum levels suggest aluminum phosphide poisoning as a potential cause of his fatal multiorgan failure.
Area of Science:
- Toxicology
- Neurology
- Critical Care Medicine
Background:
- Acute poisoning can present with diverse and severe systemic manifestations.
- Peripheral neuropathy and metabolic derangements are critical indicators of toxic exposure.
Observation:
- A young male presented with abdominal pain, vomiting, and acute symmetric peripheral polyneuropathy.
- Laboratory findings included high anion gap metabolic acidosis, elevated lactate, and persistently high arterial and venous pO2.
- Cerebrospinal fluid analysis revealed high protein content with an acellular count, and nerve conduction studies indicated axonal sensorimotor neuropathy.
Findings:
- Despite comprehensive diagnostic workup for infectious and autoimmune causes, the etiology remained elusive.
- Significantly elevated serum aluminum levels were the only conclusive diagnostic finding.
- The patient's rapid clinical deterioration led to death from multiorgan failure.
Implications:
- This case highlights the potential for aluminum phosphide poisoning to mimic other critical illnesses.
- Elevated serum aluminum may serve as a crucial diagnostic marker in unexplained fulminant cases.
- Increased awareness of aluminum phosphide toxicity is vital for prompt diagnosis and management in critical care settings.
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