Case Report Open Access

Emamectin-Chlorfenapyr-Induced Fatal Leukoencephalomyelopathy with Delayed Hyperthermia: Insecticide Endanger Public Safety

Abstract

Background: Emamectin·chlorfenapyr is a compound comprising chlorfenapyr and emamectin benzoate that is widely used in agriculture. Chlorfenapyr toxicity has been verified in animals; however, its true mechanism and progression in humans remain to be elucidated. Cases of emamectin-chlorfenapyr poisoning are very scarce.

Case presentation: We present a case of a 65-year-old female who attempted suicide by consuming 30 g of 9.5% chlorfenapyr and 0.5% emamectin benzoate 14 days before admission to our hospital. Laboratory tests revealed extremely high creatinine kinase levels upon admission. Magnetic resonance imaging revealed diffuse and symmetric T2 hyperintensities in the entire white matter tract of the brain and spinal cord, and cytological smears of the cerebrospinal fluid showed abnormal lymphocyte aggregation. The patient died 19.5 hours after admission owing to cardiopulmonary arrest and hyperthermia.

Conclusion: Further research is needed on how to perform flow cytometry in patients with emamectin-chlorfenapyr intoxication and to elucidate the immunological mechanism underlying the inflammatory response caused by emamectin-chlorfenapyr and provide new insights into antidote development.

Xun Li, Yun Yang, Yajing Zhang, Xuebin Zhang, Na Zhao, Wei Yue*

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