The Effect of Pyrethroid Ingestion on Butyrylcholinesterase Level.

We report a 45-year-old man who experienced dyspnoea, severe chest pain followed by decreased level of consciousness, and seizure-like symptoms requiring sedation and intubation. The level of high-sensitivity troponin was elevated. The patient was diagnosed in an outside institution with acute coronary syndrome along with infectious meningitis based on studies performed on cerebrospinal fluid (CSF). The patient was transferred to our hospital for further management. Cardiac ultrasound showed dilated cardiomyopathy with decreased ejection fraction. Significant coronary stenosis was excluded by coronary angiography and a polymerase chain reaction neuro-panel on the CSF came back negative. After exclusion of ACS and meningitis, detailed history taking showed that the patient's office at work had been treated with an insecticide. The product used turned out to be deltamethrin, a type II pyrethroid. The butyrylcholinesterase (BChE) level was low. Studies have shown that deltamethrin produces neurotoxicity and cardiovascular complications; however, the effect of deltamethrin on the BChE level and the development of non-ischemic cardiomyopathy remains unclear. LEARNING POINTS: Pyrethroid intoxication can lead to significant cardiotoxic effects, which necessitate prompt recognition and management.Although pyrethroids primarily act on sodium channels, they may indirectly affect cholinesterase levels, complicating the diagnostic process.Effective management of pyrethroid poisoning relies on early diagnosis, supportive care, and targeted treatment of both neurological and cardiovascular manifestations.