Cardiotoxicity Secondary to Accidental Tilmicosin (Micotil®300) Ingestion in a Young Shepherd: A Case Report

BACKGROUND Tilmicosin (Micotil®300) is a veterinary macrolide antibiotic used in the management of respiratory diseases in cattle and sheep. Human handling can lead to accidental exposures, which has been associated with severe adverse reactions, especially cardiovascular toxicity, and even death. This report describes a case of a 29-year-old male shepherd with cardiac manifestations following accidental ingestion of Tilmicosin. CASE REPORT A young man with no prior history of cardiac disease presented to the Emergency Department with syncope and severe chest pain following accidental oral ingestion of approximately 1 ml of Tilmicosin. Electrocardiography revealed ST elevation in leads V3 and V4 with sinus arrhythmia. Cardiac enzymes remained normal, and imaging studies showed no structural heart abnormalities. He was treated with supportive care alone with no adverse outcomes observed during hospitalization. CONCLUSIONS Tilmicosin has been associated with life-threatening adverse effects in humans, with this report demonstrating that even minimal non-parenteral exposure can lead to severe cardiac toxicity. This highlights the importance of raising awareness among both the public and professionals regarding safe handling practices, and the prompt initiation of medical evaluation following potential exposure. Tilmicosin should be administered by qualified professionals using standardized techniques to minimize accidental self-injuries. Further research into specific therapies for Tilmicosin toxicity is warranted to improve outcomes.