Severe pneumonitis due to prallethrin (pyrethroid) aspiration: a case report

Abstract

Prallethrin ingestion and/or aspiration can manifest in a wide range of systemic effects. Evidence-based management of chemical pneumonitis following prallethrin aspiration does not exist yet. This case presents an unusual course of illness following prallethrin ingestion/aspiration that responded to antibiotics and steroid use. This is a previously well 22-month-old boy presented to the Emergency Department (ED) with a history of estimated 20 mL ingestion/aspiration of insecticide containing prallethrin 1.6% one hour earlier. The patient had bluish discoloration of his face, with eye tearing, drooling, and frothy secretions from his mouth. The patient was admitted for supportive care and observation. During his four days of admission, he progressively improved and returned to his previously healthy baseline. However, four hours after his discharge, he relapsed and was readmitted with an impression of superimposed pneumonia. During his second course of illness, the patient had worsening of his respiratory status requiring escalation of oxygen therapy and antibiotics. The patient received 21 days of intravenous (IV) antibiotics, and steroids, and was discharged on inhaled salbutamol and fluticasone. In conclusion, pyrethroid aspiration can lead to severe pneumonitis and secondary superimposed bacterial infection.