Rehabilitation of Lower Limb Motor Dysfunction and Neurogenic Bladder After Low-Dose Chlorfenapyr Poisoning With Delayed Rhabdomyolysis: A Case Report

BACKGROUND Chlorfenapyr poisoning is a highly lethal condition that damages high-energy-demand organs such as the central nervous system. Only a few surviving patients have been reported. Survivors may develop focal neurological symptoms, including motor and urinary dysfunction, and the prognosis for these deficits remains unclear. CASE REPORT A 55-year-old man developed chest tightness, profuse sweating, dyskinesia, and paresthesia in both lower limbs, as well as urinary dysfunction, after working for 2 months in a chlorfenapyr production facility. Laboratory toxicology tests confirmed chlorfenapyr and its metabolite in his blood. Magnetic resonance imaging showed diffuse leukoencephalopathy and thoracic cord edema. After repeated detoxification, the patient became clinically stable and was transferred to the Rehabilitation Department of our hospital. Magnetic resonance imaging on admission revealed resolution of central nervous system lesions. After 2 months of pharmacologic treatment, intensive physical therapy, and neuromodulation, the patient progressed from being unable to stand to walking independently, and from indwelling catheterization to voluntary urination. However, abnormal sensations in the lower limbs and excessive sweating showed no significant improvement. CONCLUSIONS This case demonstrates the reversibility of chlorfenapyr-induced leukoencephalopathy and spinal cord lesions. It indicates that chlorfenapyr poisoning-induced motor and urinary dysfunction can be substantially improved through early and multidisciplinary rehabilitation. The persistence of abnormal sensations and sweating suggests that further investigation is required to clarify the underlying mechanisms and optimize management of these symptoms.