A Reversible Toxic Myocarditis Due to Aluminum Phosphide Poisoning

Aluminum phosphide (Phostoxin®️) is a fumigant pesticide whose intentional ingestion is a frequent method of suicide in several developing countries. Acute aluminum phosphide poisoning is a true medical emergency that can lead to severe myocardial injury and even multiorgan failure. No specific antidote is currently available. We report the case of a 24-year-old male admitted in a state of severe cardiogenic shock and coma following the voluntary ingestion of two Phostoxin®️ tablets (6 g). Initial echocardiography revealed a critically reduced left ventricular ejection fraction (LVEF) of 15%, consistent with acute toxic myocarditis. The patient underwent intensive hemodynamic resuscitation with dobutamine, norepinephrine, moderate fluid administration, and bicarbonate-based alkalinization. Mechanical ventilation was initiated from the outset. Clinical evolution was favorable, with return of urine output by 48 hours, correction of lactic acidosis, withdrawal of vasoactive drugs by Day 6 (norepinephrine) and Day 8 (dobutamine), successful ventilator weaning, and LVEF recovery to 45% by Day 10. He was subsequently transferred to psychiatric care for psychological follow-up. This case illustrates that favorable outcomes are possible even in cases of severe toxic myocarditis, provided that rapid and aggressive intensive care is implemented. Management relies on early vasopressor/inotrope support, volume resuscitation, alkalinization, and mechanical ventilation. Prognosis depends on how early diagnosis and treatment are established. Psychiatric follow-up is essential to prevent recurrence and ensure comprehensive care.