Delayed neurotoxicity after ingestion of carbamate pesticide

We studied a patient who ingested 27 gm (500 mg/kg) of carbaryl (1-naphthyl N-methylcarbamate), a popular carbamate pesticide. After he recovered from acute cholinergic toxicity, acute weakness of arms and legs was accompanied by electrophysiologic findings consistent with axonal peripheral neuropathy. Recovery began at 1 week and continued for 9 months. A similar delayed neuropathy has been described with organophosphates but not with carbamate insecticides.