TY - JOUR ID - 3732 TI - Hypersensitivity Reaction and Acute Respiratory Distress Syndrome in Pyrethroid Poisoning and Role of Steroid Therapy JO - Asia Pacific Journal of Medical Toxicology JA - APJMT LA - en SN - 2322-2611 AU - George, Jisa AU - Malik, Rupali AU - Gogna, Arun AD - Department of Internal Medicine, Safdarjang Hospital, Vardhman Mahavir Medical College, Guru Gobind Singh Indraprastha University, New Delhi, India Y1 - 2015 PY - 2015 VL - 4 IS - 2 SP - 91 EP - 93 KW - Adult Respiratory Distress Syndrome KW - Hypersensitivity KW - Methylprednisolone KW - Poisoning, Pyrethrins DO - 10.22038/apjmt.2015.3732 N2 - Background: Pyrethroids are generally of low toxicity to humans, but in suicidal poisonings which are usually associated with ingestion of high doses, they lead to severe systemic effects. Case Report: A 30-year old woman presented to emergency department with a history of intentional ingestion of about 15 mL of prallethrin around 3 days earlier. She complained of shortness of breath along with chest pain for the last 2 days. She reported no vomiting or stomach pain prior to presentation to hospital. On chest auscultation, breath sounds were mildly decreased in bilateral infrascapular areas with generalized crepitation. Arterial blood gas analysis revealed respiratory alkalosis. Chest X ray and computed tomography of thorax revealed widespread confluent areas of consolidation with interlobular septal thickening involving bilateral parahilar regions suggestive of acute respiratory distress syndrome (ARDS). The patient did not respond to broad spectrum antibiotic coverage, diuretics and oxygen inhalation. Intravenous methylprednisolone (2 mg/kg/day divided 6 hourly) was started and slowly tapered off during the next days. The patient discharged after 3 weeks in good health. Discussion: As pyrethroids can affect sodium channels, the osmotic gradient of alveolar epithelium probably disrupts and therefore, alveolar infiltrations gradually spread over lungs. In addition, there is a possibility of hypersensitivity reactions to pyrethroids, which can cause progressive inflammation and involve respiratory tract in severe cases. Conclusion: Pyrethroid poisoning can lead to ARDS. Steroid therapy may help such patients tide over the pulmonary crisis. UR - https://apjmt.mums.ac.ir/article_3732.html L1 - https://apjmt.mums.ac.ir/article_3732_e168ef655ddfb3a7e1b1660b3482d6aa.pdf ER -