A case of delayed encephalopathy after acute carbon monoxide poisoning in a burn patient

• Delayed encephalopathy diagnosed after carbon monoxide poisoning in a burn patient. • Waxing and waning with ultimate neurologic decline despite initial recovery. • Thalamic and basal ganglia changes on MRI consistent with CO neurotoxicity. Delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) is a rare complication of carbon monoxide poisoning, presenting with waxing and waning of neuropsychiatric symptoms days to weeks after initial carbon monoxide poisoning. In this case report, we present a case of delayed neuropsychiatric sequelae and demise in a 48-year-old male who suffered 22 % total body surface area burns in a house fire. Initial management included intubation, administration of hydroxocobalamin, and Parkland resuscitation protocol. Despite initial recovery, his neurological status fluctuated, developing hepatic and renal failure, and septic shock. He underwent multiple surgeries and procedures, including tracheostomy, debridement, and grafting, but remained unresponsive with waxing and waning neurological symptoms. A later brain MRI revealed abnormalities in the basal ganglia and thalami, suggestive of DEACMP. Based on the clinical presentation and radiologic findings, an attending neurologist at our institution agreed with this diagnosis before the patient’s demise. This case emphasizes the need for vigilant monitoring of burn patients for carbon monoxide poisoning and delayed neuropsychiatric sequelae. There are emerging therapies that may assist in the recovery of neuropsychiatric functioning, but further studies are necessary to guide treatment strategies for DEACMP.