Endrin Poisoning Complicated by Rhabdomyolysis-associated Acute Kidney Injury: Two Rare Case Reports

Acute kidney injury (AKI) caused by rhabdomyolysis following a single episode of seizure is a rare entity. We report a rare case of food poisoning contaminated with pesticides, complicated by a seizure episode. This was followed by rhabdomyolysis and AKI in two members of the same family. The diagnosis of rhabdomyolysis was supported by a markedly elevated level of serum creatinine phosphokinase. Both patients underwent hemodialysis and subsequently made a rapid and complete recovery. Under further investigations, the contaminated source of food was identified. Toxicological screening led to the identification of the pesticide endrin as the cause of the seizure and rhabdomyolysis-associated AKI. The cause of AKI in both cases was attributed to acute rhabdomyolysis. Endrin is known to cause renal insufficiency by various mechanisms, including direct acute tubular injury, interstitial edema, and impaired autoregulation of renal blood flow. The temporal relationship between ingestion of the endrin-contaminated food and the development of seizures preceding acute rhabdomyolysis supported this fact. As endrin is known to cause seizures, especially in the absence of other etiologies for rhabdomyolysis, our cases supported the occurrence of endrin-induced rhabdomyolysis following seizures.