Clinical features and management of poisoning due to nitrobenzene containing pesticide and plant growth stimulator: a case report

Nitrobenzene poisoning is a rare life threatening event with lethal outcomes if not intervened promptly. Nitrobenzene is an oxidizing compound and is an active ingredient of pesticides, plant growth stimulators, lubricating oils, etc. It leads to accumulation of methemoglobin (MetHb) in blood which hampers oxygen carrying capacity of RBC. Depending on its level in blood it can present with range of symptoms most prominent being cyanosis. We present a case of 19-year-old male patient with accidental nitrobenzene poisoning. He presented with cyanosis, headache, vomiting and his oxygen saturation (SpO2) was 89% on room air which didn’t improve with oxygen therapy. Patient informed use of pesticides on his farm one day back. On asking further the chemical was identified which contained nitrobenzene as its key ingredient. Venous blood samples were taken which were chocolate dark in color. On basis of clinical features and history given methemoglobinemia due to nitrobenzene poisoning was suspected. He was treated with intravenous (IV) methylene blue, vitamin C, multivitamins and fluid and oxygen therapy. Patient recovered completely after ten days with all blood reports within normal range and later was discharged. Patient was good at health at his follow up after three weeks of discharge. Therefore, it is advisable to be expeditious in diagnosing nitrobenzene poisoning and treating subsequent methemoglobinemia with its antidote methylene blue to prevent fatal results.