A Pediatric Case of Benzodiazepine Poisoning Diagnosed Following the Appearance of a Brilliant Blue Tongue

Benzodiazepines are one of the commonly used prescription anxiolytic drugs; however, they are increasingly used for drug abuse, drug crime, and sometimes for medical child abuse. To prevent misuse of high-potency benzodiazepines, some of them are currently manufactured as a tablet with a speckled blue core that dyes liquid blue when dissolved in drinks. Diagnosing drug poisoning, especially in cases of medical child abuse, can be challenging when signs of ingesting drugs, including empty medical packages, are missing. Herein, we report an infant's case of benzodiazepine poisoning, who was diagnosed with disturbed consciousness and a blue-colored tongue. An 11-month-old boy was referred to our hospital as his tongue was colored blue. According to his family, no blue-colored items were found around him when they noticed his tongue was blue. Physical examination revealed his consciousness was slightly disturbed. Benzodiazepine poisoning was suspected from his level of consciousness and blue-colored tongue, and it was detected using a urine drug test kit (SIGNIFY ER). Medical child abuse was suspected, as accidental ingestion was not likely to happen in the circumstances heard from his family members. Everyone around him denied having benzodiazepine, and how he ingested the medicine was not revealed despite intensive investigation by the police. Benzodiazepine poisoning should be considered in patients presenting with a blue tongue with disturbed consciousness. Adding dyes to medicines commonly used for poisoning may be helpful in recognizing and preventing child abuse.