Prolonged cholinergic toxidrome with markedly low cholinesterase activity after exposure to emamectin benzoate emulsion: A case report.
Hideo Chubachi, Noritaka Kitazume, Kenji Momo et al.
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Case in brief
An elderly man with chronic kidney disease ingested emamectin benzoate emulsion, presenting on day 2 with abdominal pain, diarrhea, and significant sialorrhea. His serum cholinesterase levels dropped markedly to 18 U/L. Despite supportive care, he experienced worsening symptoms, including pinhole miosis and further cholinesterase suppression to 2 U/L by day 5. After atropine administration and close monitoring, his symptoms gradually resolved, with partial recovery of cholinesterase levels by days 75-95.
What made this case unusual
The case highlights prolonged cholinergic symptoms and markedly low cholinesterase activity after exposure to a non-organophosphate insecticide, which is atypical and warrants attention.
Diagnostic / clinical pearl
Clinicians should be aware that exposure to non-organophosphate insecticides like emamectin benzoate can lead to prolonged cholinergic symptoms and significant cholinesterase suppression.
Why it matters
This case emphasizes the importance of serial monitoring and follow-up in patients with pesticide exposure, as initial stability may not predict later complications.