Fatal Amitraz Poisoning: A Case Report

Amitraz is insecticide and acaricide derived from formamidine which is commonly used in veterinary and agricultural practice, which has a significant risk of accidental, occupational, or intentional exposure. Even though, Amitraz poisoning is very rare clinical presentation, it can mimic organophosphate poisoning due to overlapping features such as bradycardia, hypotension, and respiratory depression, increasing the risk of misdiagnosis. In this article, we report a fatal case of Amitraz poisoning in a 25-year-old female who ingested the compound with suicidal intent. She developed severe toxic symptoms and died approximately 36 hours post-ingestion. Autopsy revealed 100 ml of greenish-brown, pungent gastric contents, congestion of the gastric mucosa and internal organs, and chemical analysis confirmed Amitraz in viscera. Histopathology showed focal sinusoidal dilation, mild steatohepatitis, zone-3 necrosis, and inflammatory infiltrates in the liver; acute tubular necrosis and degenerative changes in the kidneys; and diffuse alveolar hemorrhages, pulmonary oedema, and thickened alveolar septa in the lungs. To distinguish Amitraz poisoning from organophosphate poisoning, clinicians should note the absence of a hypersecretory state, the presence of hypothermia, frequent hyperglycaemia, and normal serum cholinesterase levels in Amitraz poisoning. Early recognition of these differences is essential to ensure correct diagnosis and prompt, appropriate treatment.