Magnetic Resonance Imaging and Clinical Features of Chlorfenapyr-Induced Toxic Leukoencephalopathy: A Case Report

Abstract

Chlorfenapyr is widely used as an insecticide, despite it being fatal to humans. However, chlorfenapyr-induced central nervous system toxicity has rarely been reported. We report the magnetic resonance imaging (MRI) findings in a rare case of chlorfenapyr-induced toxic leukoencephalopathy. A 71-year-old man who had ingested chlorfenapyr approximately two weeks prior visited our hospital and presented with bilateral lower motor weakness and voiding dysfunction that had developed two days before admission. Brain MRI revealed extensive bilateral white matter abnormalities involving the corpus callosum, internal capsule, brain stem, and bilateral middle cerebellar peduncle. Furthermore, spine MRI revealed diffuse swelling and hyperintensity on the T2-weighted images.

Brain damage caused by chlorfenapyr poisoning: a case report and literature review

“…We searched articles using "chlorfenapyr" and "case" as keywords in titles and abstracts in PubMed, EMBASE, Google Scholar, and Scopus databases from 01/01/1970 to 03/01/2021 and found 12 case reports with full text (Table 2) (Ref. [3][4][5][6][7][8][9][10][11][12][13][14]…”

“…The patients who swallowed 300 mL [5] or 250 mL [6] of chlorfenapyr died despite hemodialysis (HD) probably owing to the excessive intake. A 71-year-old-male [13] swallowed 100 mL of chlorfenapyr and died because of the excessive intake. A 66-year-old-male [7] ingested 20 mL of chlorfenapyr and died despite continuous renal replacement treatment (CRRT) and HP.…”

Types and Toxicity Levels of Pesticides: A Study of an Agricultural Area in Brebes Regency

“…For example, a 49-year-old patient died five days after exposure to this pesticide (73). Another study revealed the clinical feature of chlorfenapyr-induced toxic leukoencephalopathy in a 71-year-old male patient (74). The risk for pancreatic cancer is higher after exposure to the dinitroaniline group, such as pendimethalin (40).…”

Hemoperfusion and continuous veno-venous hemodiafiltration for eliminating chlorfenapyr in poisoning patients

“…[1] Symptoms of chlorfenapyr poisoning in patients are mild and atypical in the early stage, especially in patients receiving low dose exposure; however, such cases are rare and may be ignored by physicians, often leading to delayed treatment. [2,3] Once the hypothalamus thermoregulatory center and medulla oblongata respiratory and heartbeat centers are involved, patients often develop hyperthermic coma, leading to death. [2][3][4][5] At present, there is no specific antidote or effective treatment for chlorfenapyr poisoning.…”

“…[2,3] Once the hypothalamus thermoregulatory center and medulla oblongata respiratory and heartbeat centers are involved, patients often develop hyperthermic coma, leading to death. [2][3][4][5] At present, there is no specific antidote or effective treatment for chlorfenapyr poisoning. The reported mortality rate is 38.0%-87.5%.…”