New-Onset Convulsive Status Epilepticus Temporally Associated With Accidental Inhalation of Billygoat Weed (Ageratum conyzoides) Smoke: A Case Report.

Status epilepticus is most commonly associated with structural, metabolic, infectious, autoimmune, or toxic etiologies. Plant-related toxic exposures are uncommon causes of new-onset status epilepticus and remain poorly characterized. Ageratum conyzoides (billygoat weed) is an invasive plant widely distributed in tropical and subtropical regions and is frequently used in traditional medicine. We report the case of a 76-year-old male with no prior history of epilepsy, cerebrovascular disease, dementia, head injury, alcohol use, or substance abuse who developed generalized convulsive status epilepticus approximately five minutes after the accidental inhalation of smoke generated from burning Ageratum conyzoides. He presented to the emergency department with ongoing seizures requiring treatment with intravenous benzodiazepines, endotracheal intubation, and ICU admission. Extensive investigations, including cerebrospinal fluid analysis, metabolic profile, thyroid function testing, renal and liver function tests, autoimmune workup, urine toxicology, blood ketone levels, and carbon monoxide levels, were unremarkable. Contrast-enhanced MRI of the brain demonstrated diffuse cerebral atrophy with Fazekas grade 2 white matter changes but without evidence of an acute structural lesion to account for the seizures. Electroencephalography (EEG) performed following stabilization was normal. The patient's condition improved clinically; he was successfully extubated and discharged after a three-day ICU stay. He remained neurologically intact and seizure-free at the three-month follow-up. This report highlights a possible association between Ageratum conyzoides smoke inhalation and new-onset status epilepticus and underscores the importance of considering environmental toxin exposure in patients presenting with unexplained seizures.