Rhabdomyolysis with Involvement of Palato-Pharyngeal Musculature in Hair Dye (PPD) Poisoning - A Case Report

A 35 year old female presented to us after consuming hair dye with features of rhabdomyolysis with involvement of palato-pharyngeal musculature. PPD (para-phenylene diamine has been used for dyeing furs, photochemical measurements, dyeing hairs and azo-dye manufacturing. After oral ingestion patients usually develops angioneurotic edema, Rhabdomyolysis, intravascular hemolysis, acute renal failure and cardiotoxicity. In our case neck swelling had subsided within 8–10 hours. Motor weakness and tenderness was present in all groups of muscles of all the extremeties. Involvement of palato-pharyngeal musculature results in difficulty in swallowing. Oral cavity examination revealed absent palatal movement and pooling of saliva. On testing gag reflex, there was slight constriction of the posterior pharyngeal wall without any movement of soft palate. Indirect laryngoscopy revealed diminished movement of vocal cord. All the cranial nerves were intact. On admission CPK, SGPT, SGOT were elevated. Her EMG discloses typical myopathic pattern. Palato pharyngeal involvement is thought to be part of generalised toxic myopathy as supported by EMG and rise in CPK. This was further supported by the fact that patient responded to treatment with steroid and her CPK also came down after treatment. Patient showed gradual but complete improvement in her motor power of all limbs. There was gradual improvement in her palatal movement, albeit incomplete and there was increase in the volume of speech. The prevention and treatment of PPD poisning by public enlightenment is mandatory in the effort to reduce poisoning by this agent.