Multiple Unusual Complications in a Single Patient with Combined Organophosphate-Carbamate Pesticide Exposure

Poisoning with organophosphate (OP) or carbamate (CM) pesticides is very common in India. These compounds are powerful inhibitors of acetylcholinesterase, causing accumulation of acetylcholine resulting in muscarinic and nicotinic effects. In addition, there are often direct CNS effects including headache, tremor, delirium, slurred speech, ataxia, and convulsions. Coma supervenes in the later stages.

Apart from these, OP poisoning can also induce an “intermediate syndrome” (IMS) characterized by proximal muscle weakness and paralysis; a “delayed syndrome” (organophosphate-induced delayed neuropathy or OPIND) characterized by polyneuropathy and weakness of distal limb muscles; and neuropsychiatric disturbances (chronic organophosphate-induced neuropsychiatric disorder or COPIND). Other disorders have very rarely been reported, such as Guillain-Barre syndrome, Parkin-sonism, transient hepatic dysfunction, pancreatitis, vocal cord paralysis, etc.

We report a case of combined organophosphate-carbam-ate poisoning with multiple complications, e.g., intermediate syndrome (IMS), delayed neuropathy (OPIND), and Parkinsonism. These complications are rare, and some of them to the best of our knowledge have not been reported so far.