Acute cypermethrin and other pyrethroid poisoning - An organophosphate-like poisoning: A case report and review.

Background: South Africa is one of the largest importers of pesticides in Africa. Pesticides play an integral role in food security and ensuring economic survival. Cypermethrin is a type II pyrethroid and is commonly and widely used as an insecticide. Poisoning arises from exposure through inhalation, skin contact or ingestion. Its toxic effects manifest predominantly as neurological and gastrointestinal symptoms. Severe pyrethroid poisonings are rare but can present as an organophosphate-like toxidrome. This poses a diagnostic conundrum. Case report: This case concerns a 36-year-old male from a rural town in the Eastern Cape province of South Africa, who was diagnosed with intentional cypermethrin poisoning after a suicide attempt. He was initially diagnosed as a suspected organophosphate poisoning with coma. He made a full recovery after mechanical ventilation and symptomatic treatment with a low dose muscarinic antagonist, atropine sulphate. Conclusions: With the ease of over-the-counter procurement, cypermethrin and other pyrethroid poisonings pose an increasing diagnostic dilemma to frontline and critical care personnel. This case report intends to raise awareness about the organophosphate-like toxidrome at presentation and the potential complications of high dose atropine treatment, commonly used to treat organophosphate poisoning. The treatment of cypermethrin is largely supportive with dermal decontamination of skin as an essential component. Low dose atropine may be utilized if required.