Bilateral Loculated Pleural Effusion as a Manifestation of Acute Parenteral Organophosphate Intoxication: A Case Report

Abstract

Background Acute organophosphate (OP) toxicity causes a wide range of clinical effects on the respiratory system, including pulmonary bronchoconstriction and bronchorrhea. Morbidity and mortality from acute OP toxicity correlate best with pulmonary secretions. Objective In this article, we report bilateral loculated pleural effusion as a rare pulmonary effect in a patient with acute parenteral OP toxicity. Case Report A 25-year-old, previously healthy woman was transferred to our Poison Department 3 days after suicidal injection of malathion. At the time of presentation her vital signs were normal, except that her respiratory rate was 24 breaths/min. She complained of pleuritic chest pain and had a cough productive of yellow sputum. She had generalized chest wall tenderness, and breath sounds were decreased in the base of both lung fields. Standard therapy for OP toxicity, including atropine, pralidoxime, and diazepam, was initiated. Due to persistent pleuritic chest pain, a computed tomography (CT) scan was performed that showed bilateral loculated pleural effusions. Shortly after hospital admission, the patient developed respiratory distress, for which she was intubated and transferred to the Intensive Care Unit. She received continued medical therapy and was extubated on hospital day 3. A CT scan of the chest on hospital day 9, after completion of the treatment, documented resolution of the effusions. Conclusion Parenteral OP toxicity occurs rarely, and in this case it was associated with bilateral loculated pleural effusions. In this regard, it should be considered in a patient with acute parenteral OP toxicity and persistent chest wall pain.