Unmasking the Culprit: A Case Report of Life-threatening Bleeding in a Child Due to Superwarfarin Toxicity

Abstract: Superwarfarin, a potent rodenticide, can cause severe and prolonged anticoagulant effects, resulting in life-threatening bleeding in cases of accidental ingestion, which is especially challenging to diagnose in children, as the exposure may be unwitnessed and undetected by standard toxicology screens. We report the case of a young child who presented with significant, life-threatening bleeding. Initial management included intensive care support, transfusions, fresh frozen plasma, cryoprecipitate, and recombinant factor VII, all aimed at stabilizing the patient’s coagulopathy. Despite aggressive hemostatic support, bleeding continued, prompting further investigation. Eventually, superwarfarin ingestion was suspected, and high-dose Vitamin K therapy was initiated, continuing for several months due to the compound’s extended half-life. The child showed marked clinical improvement with sustained Vitamin K therapy, with regular international normalized ratio monitoring guiding dosage adjustments. This case highlights the diagnostic and therapeutic challenges of superwarfarin toxicity in pediatric patients, emphasizing the need for high clinical suspicion in cases of unexplained, persistent bleeding. It underscores the importance of multidisciplinary care and extended Vitamin K therapy for successful management. Awareness of this rare but serious cause of coagulopathy is essential for timely diagnosis and intervention.