Bilateral putaminal necrosis and bronopol toxicity

Marina Trivisano

Elena Carapelle

Tommaso Martino

Luigi Specchio

^{Clinic of Nervous System Diseases, Ospedali Riuniti Foggia, University of Foggia, Foggia, Italy}

^{Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy}

^{Dr Marina Trivisano,}moc.liamg@onasivirt.aniram

Accepted 2015 Jan 29.

Abstract

Among alcohols, methanol intoxication is the most frequently associated with cerebral toxicity, causing retinal damage and putaminal necrosis. This consequence is believed to be due to the transformation of methanol into formic acid. We describe the case of a patient who presented with acute impairment of consciousness and tetraparesis after she had been drinking several bottles of a topical antiseptic solution (Lysoform Medical) containing 2-bromo-2-nitro-1,3-propandiol (bronopol) among excipients, in order to lose weight during previous months. Moreover, she had been on a strict slimming diet. Soon after admission, a severe respiratory and metabolic impairment became rapidly evident, requiring an intensive care unit admission. Cerebral MRI showed the presence of bilateral putaminal necrosis. She recovered in 10 days, surprisingly, without any evident clinical neurological signs. Methanol, also bronopol, when diluted in aqueous solution, at warm temperature and/or higher pH, may release formaldehyde, which is converted into formic acid, a basal ganglia toxic compound.

Abstract

Learning points

Acknowledgments

The authors thank Dr Anna Lepore of the Poison Control Centre of Riuniti Hospital of Foggia and Dr Cosma Andreula of the neuroradiology Unit of Anthea Hospital of Bari for their suggestions. Dr Gianpaolo Grilli for performing the cerebral MRI, Dr Donato Melchionda for choosing the images and commenting on them, and Dr Maria Grazia Pascarella and Giuseppe d'Orsi for their contribution in revising the article. They also thank Professor Silvia Gliatta for the English editing.

Acknowledgments

Footnotes

Contributors: All the authors actively participated in article drafting. MT, EC and TM followed the case and collaborated in writing the article. MT and TM prepared figures. LMS revised the article, and supervised and coordinated the team work.

Competing interests: None.

Patient consent: Obtained.

Provenance and peer review: Not commissioned; externally peer reviewed

Footnotes

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