Emamectin·Chlorfenapyr-Induced Fatal Leukoencephalomyelopathy with Delayed Hyperthermia

Abstract Background Emamectin·chlorfenapyr is compounded with chlorfenapyr and emamectin benzoate. It has been wildly used in agriculture. Although chlorfenapyr toxicity has been verified in animals, the true mechanism and progression in human beings still needs to be unveiled. Furthermore, cases of the compound emamectin·chlorfenapyr poisoning are very scarce. Case presentation: We present the case of a 65-year-old female who had attempted suicide by taking 30g of 9.5% chlorfenapyr and 0.5% emamectin benzoate orally 14 days before being admitted to our hospital. Laboratory tests showed extremely high creatinine kinase levels on admission. Magnetic resonance imaging showed diffuse and symmetric T2 hyperintensity in entire white matter tract of brain and spinal cord. Cerebrospinal fluid cytology pathological smear showed abnormal lymphocyte aggregation. 19.5 hours after admission, the patient died because of cardiopulmonary arrest and hyperthermia. Conclusions Further research is needed on performing flow cytometry in emamectin·chlorfenapyr intoxication patients and elucidating immunological mechanism beneath the inflammatory process caused by emamectin·chlorfenapyr, and providing new thoughts in antidotal drug development.