Introduction: Organophosphorus poisoning (OP) represents a significant public health issue, particularly in developing countries, due to its extensive availability and high toxicity. Standard management includes atropine and oximes such as Toxogonin; however, emerging evidence suggests potential adverse effects associated with oximes.
Case presentation: This case report examines the uncommon occurrence of acute kidney injury (AKI) in a 64-year-old Egyptian farmer following accidental dermal and inhalational exposure to OP pesticides. The patient presented with symptoms of OP poisoning, including dizziness, sweating, and fasciculations. Initial treatment with atropine and Toxogonin (obidoxime) resulted in temporary symptomatic improvement. Nevertheless, renal function progressively deteriorated after initiating Toxogonin therapy, evidenced by elevated urea and creatinine levels. Renal impairment coincided temporally with Toxogonin administration and improved following its cessation.
Discussion: Potential mechanisms of Toxogonin-induced AKI include direct nephrotoxicity, altered renal perfusion, or immune-mediated injury. Other causes, such as rhabdomyolysis, systemic hypotension, or intrinsic OP nephrotoxicity, were ruled out to reinforce the likelihood of oxime-related renal impairment. While oximes are essential in OP poisoning management, this case emphasizes the necessity for clinical vigilance concerning their potential nephrotoxic effects.
Conclusion: The findings highlight the need to reassess the use of oximes, especially in patients with pre-existing renal conditions. Furthermore, additional research is required to elucidate the mechanisms and determine risk factors associated with oxime-induced nephrotoxicity.