Intraspinal hematoma caused by anticoagulant rodenticide poisoning: a rare case report

Introduction: Anticoagulant rodenticide poisoning is a significant public health issue, particularly in rural areas. Common clinical manifestations include mucocutaneous bleeding, hematuria, gastrointestinal bleeding, and ecchymosis. While intracranial hemorrhage is a recognized and serious complication, the occurrence of an intraspinal hematoma (ISH) secondary to such poisoning is exceptionally rare, with no well-documented cases in the existing literature. Case presentation: We report the case of a 78-year-old male farmer who presented with severe right lower limb pain of 5 days' duration. His history revealed ingestion of an unknown rodenticide approximately 1 month prior, followed by episodes of hematuria and hematemesis that had been partially treated with vitamin K1. Upon admission, he exhibited a severe coagulopathy with markedly elevated prothrombin time and International Normalized Ratio. Magnetic resonance imaging of the lumbar spine revealed an intraspinal mass at the L1 level, which was subsequently confirmed to be a hematoma on a contrast-enhanced study. The patient was diagnosed with an intraspinal hematoma complicating SUPERWARFARIN poisoning. Management included the administration of vitamin K1 and fresh frozen plasma, leading to a gradual normalization of coagulation parameters and symptomatic improvement. Conclusion: This case highlights a highly unusual and severe neurological complication of presumed anticoagulant rodenticide poisoning. It underscores the critical importance of maintaining a high index of suspicion for hemorrhagic events in unusual anatomical locations in patients with a history of rodenticide exposure and unexplained coagulopathy.