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

Chlorfenapyr poisoning is uncommon, but fatal, and is often ignored. Chlorfenapyr inhibits ATP production in the mitochondrial of lipid-rich organs such as the brain. The initial symptoms of chlorfenapyr poisoning are not serious and are usually ignored; fever and unconsciousness are the main signs. Patients often die of brain damage, and survivors often present toxic leukoencephalopathy. We report a case of a 15-year-old female who swallowed 10 mL of 10% chlorfenapyr, and was subjected to gastric lavage one hour after ingestion. The patient felt no discomfort on the first and second day after lavage and went to school. On the third day, the patient complained of a headache and rested at home. On the fourth day, the patient still complained of headache, and the condition progressed to confusion and fever; therefore, the patient was admitted to the emergency room and underwent hemoperfusion. Cerebral CT revealed diffuse brain edema. The patient died on the fourth day because of central fever, brain hernia, and brain dysfunction. Chlorfenapyr poisoning is fatal, even in small doses. Patients suspected of chlorfenapyr poisoning should be closely observed and promptly treated by hemoperfusion.

Poisoning; Chlorfenapyr; Leukoencephalopathy; Hemoperfusion

[1] Herron GA, Rophail J, Wilson LJ. Chlorfenapyr resistance in two-spotted spider mite (Acari: Tetranychidae) from Australian cotton. Experimental and Applied Acarology. 2004; 34: 315–321.

[2] Periasamy S, Deng J, Liu M. Who is the real killer? Chlorfenapyr or detergent micelle-chlorfenapyr complex? Xenobiotica. 2017; 47: 833–835.

[3] Ku JE, Joo YS, You JS, Chung SP, Lee HS. A case of survival after chlorfenapyr intoxication with acute pancreatitis. Clinical and Experimental Emergency Medicine. 2015; 2: 63–66.

[4] Baek BH, Kim SK, Yoon W, Heo TW, Lee YY, Kang HK. Chlorfenapyr-induced toxic leukoencephalopathy with radiologic reversibility: a case report and literature review. Korean Journal of Radiology. 2016; 17: 277–280.

[5] Chomin J, Heuser W, Nogar J, Ramnarine M, Stripp R, Sud P. Delayed hyperthermia from chlorfenapyr overdose. The American Journal of Emergency Medicine. 2018; 36: 2129.e1–2129.e2.

[6] Choi UT, Kang GH, Jang YS, Ahn HC, Seo JY, Sohn YD. Fatality from acute chlorfenapyr poisoning. Clinical Toxicology. 2010; 48: 458–459.

[7] Luo ZH, Chen YQ, Lin JR, Jiang WZ. A case report of death from acute emamectin·chlorfenapyr poisoning. Chinese Journal of Industrial Hygiene and Occupational Diseases. 2020; 38: 534–535.

[8] Tharaknath VR, Prabhakar YVS, Kumar KS, Babu NK. Clinical and radiological findings in chlorfenapyr poisoning. Annals of Indian Academy of Neurology. 2013; 16: 252–254.

[9] Kang C, Kim DH, Kim SC, Kim DS. A patient fatality following the ingestion of a small amount of chlorfenapyr. Journal of Emergencies, Trauma, and Shock. 2014; 7: 239–241.

[10] Lee J, Lee JH, Baek JM, Lee DS, Park IY, Won JM, et al. Toxicity from intra-abdominal injection of chlorfenapyr. Case Reports in Emergency Medicine. 2013; 2013: 425179.

[11] Han S, Yeom S, Lee S, Park S, Kim H, Cho Y, et al. A fatal case of chlorfenapyr poisoning following dermal exposure. Hong Kong Journal of Emergency Medicine. 2019; 26: 375–378.

[12] Kim IS, Kim JH, Kim JB, Kim JH. Chlorfenapyr intoxication manifested by extensive leukoencephalomyelopathy. Journal of the Korean Neuro-logical Association. 2018; 36: 390–392.

[13] Kim JH, Park NH, Park JY, Kim S. Magnetic resonance imaging and clinical features of chlorfenapyr-induced toxic leukoencephalopathy: a case report. Journal of the Korean Society of Radiology. 2020; 81: 985–989.

[14] Park SJ, Jung JU, Kang YK, Chun BY, Son BJ. Toxic optic neuropathy caused by chlorfenapyr poisoning. Journal of the Korean Ophthalmological Society. 2018; 59: 1097–1102.

[15] Kumar Y, Drumsta D, Mangla M, Gupta N, Hooda K, Almast J, et al. Toxins in brain! Magnetic resonance (MR) imaging of toxic leukoencephalopathy—a pictorial essay. Polish Journal of Radiology. 2017; 82: 311–319.

[16] Ghannoum M, Bouchard J, Nolin TD, Ouellet G, Roberts DM. Hemoperfusion for the treatment of poisoning: technology, determinants of poison clearance, and application in clinical practice. Seminars in Dialysis. 2014; 27: 350–361.

[17] Kade G, Spaleniak S, Antosiewicz S. Continuous renal replacement therapy as a treatment of selected acute intoxications. Polski Merkuriusz Lekarski. 2020; 49: 250–254.