జర్నల్ ఆఫ్ డెవలపింగ్ డ్రగ్స్
అందరికి ప్రవేశం

నైరూప్య

Blackstone toxicity presenting as posterior reversible encephalopathy syndrome

Shafaq Saleem

Abstract:
Black stone or Paraphenylenediamine (PPD) is commonly used in industries as hair dye. Commonly taken as poisoning mostly in South-East Asian women, it causes lipid peroxidation of membrane and free radical formation causing fatal muscle necrosis, angio-neurotic edema, myocarditis, toxic hepatitis and renal failure. We describe case of a 25 year old female confessing the ingestion of hair dye as suicidal attempt, who came to emergency department with breathing difficulty and drowsiness. She was immediately intubated due to threatened airway. During intubation laryngeal edema was seen with no visualization of vocal cords. During the three days of intubation patient was managed toxic hepatitis, rhabdomyolysis and poisoning. Post extubation on day 4 of her hospital stay, she developed generalized tonic clinic seizures two to three episodes lasting for around 45 to 60 seconds. MRI Brain revealed diffuse bilateral symmetrical abnormal signal intensity areas in supratentorial and infratentorial brain is highly suggestive of posterior reversible encephalopathy syndrome .Patient was started on injection levetiracetam after giving  loading dose and remained seizure free on maintenance dose. The patients don’t have renal failure or the need for hemodialysis.
PRES syndrome signifies disruption of blood brain barrier and vasogenic edema due to wide variety of etiologies. As per our literature review, although hepatic disorder has been mentioned as a cause of PRES and PPD as a cause of seizure in a few case reports, there has been no case mentioning PPD as a cause of PRES by either direct toxicity or indirectly by causing toxic hepatitis.
We, therefore presents a unique case of Paraphenylenediamine poisoning leading to PRES syndrome. In cases of PPD poisoning, PRES should be considered once underlying metabolic causes of seizures e.g. renal failure have been ruled out. Complete psychological assessment and rehabilitation of the patient is obligatory once patient is stabilized.