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“The Toxic Depot”: Parenteral Insecticide Injection

Groups and Associations Jerry Jacob1 , Karthik Reddy CH2 , Jobin James
Indian Journal of Critical Care Medicine 2022

Background: Organophosphorus (OP) pesticides are extensively used both in developed and developing countries. Organophosphorus 
poisoning primarily occurs through occupational, accidental, and suicidal exposures. Toxicity through parenteral injections is seldom reported 
and there are only very few case reports till date.
Case presentation: We report a case of parenteral injection of 10 mL of OP compound (Dichlorvos 76%) into a swelling over the left leg. The 
compound was injected by the patient himself as adjuvant therapy for swelling. Initial manifestations included vomiting, abdomen pain, and 
excessive secretions followed by neuromuscular weakness. The patient was subsequently intubated and treated with atropine and pralidoxime. 
The patient did not improve with antidotes for OP poisoning, attributed to the depot the OP compound had formed. The swelling was excised 
and the patient immediately showed response to the treatment. Biopsy of the swelling showed granuloma and fungal hyphae. The patient 
developed intermediate syndrome during the ICU stay and was discharged after 20 days of hospital stay.