Tongue granuloma: An unusual complication of potassium permanganate ingestion

Abstract

Potassium permanganate (KMnO4 ) is a powerful oxidising agent. In its raw form, it is an odourless, sweet-tasting, dark-purple substance, available in ready-to-use solutions, pellets, tablets, crystals and powder form. In clinical practice historically, it has been used as an antiseptic and antifungal agent. In rural South African communities, however, KMnO4 has many traditional uses, including use as a snake repellent, a treatment for constipation, joint pains, open wounds, urticaria and even for casting out spells. KMnO4 is kept in most households in rural Limpopo Province, and is therefore easily accessible by children, and alluring because of its sweet taste and similarity to candy. The corrosive effects of KMnO4 ingestion on the gastrointestinal tract are secondary to the formation of potassium hydroxide, a strong alkaline corrosive which causes liquefactive necrosis, allowing deep penetration into mucosal tissue as cells are destroyed. The most common adverse effect of KMnO4 ingestion observed in our practice, and reported in this case report, is an oesophageal stricture. This adverse event often results in children dying from severe gastrointestinal bleeds or complications of tracheoesophageal fistula associated with upper airway obstruction.