Medicolegal evaluation of methanol poisoning from illicit alcohol: a five-case series

Methanol poisoning resulting from illicit alcohol consumption constitutes a major public health problem and may lead to severe metabolic acidosis, visual disturbances, and significant medicolegal implications. This case series describes five male patients who ingested illicit alcohol and were managed at a center without access to serum methanol measurement. All patients presented with high-anion-gap metabolic acidosis and visual symptoms, allowing a clinical diagnosis of methanol poisoning despite the absence of toxicological confirmation. Emergency hemodialysis was performed in all cases, and ethanol infusion was used as the primary antidotal therapy in four patients. While four cases achieved complete visual recovery, one developed persistent optic neuropathy consistent with methanol-related toxic injury. From a forensic perspective, all cases were classified as "life-threatening conditions," and two patients required scheduled follow-up evaluations to assess potential permanent functional impairment. This series highlights that reliable clinical diagnosis and effective management are achievable even in resource-limited settings and underscores the importance of prompt therapeutic intervention, careful visual assessment, and accurate medicolegal documentation in suspected methanol intoxication.