Use of a Topical Salicylate Product Leading to Death: A Case Report

Introduction: Systemic salicylate poisoning can occur when products containing salicylates are applied to inflamed skin or when high concentrations are used for prolonged periods. Significant morbidity and mortality from dermal salicylate exposure are rarely reported. We present a fatal case of topical salicylate poisoning. Case: A 25-year-old female with vitiligo came to the emergency department by ambulance. Her sister reported that the patient had been using a topical skin whitening product for the preceding two weeks. We later found this to contain salicylate. She was critically ill, with abdominal pain, vomiting, and diarrhea. She received intravenous fluids and empirical antibiotics for suspected sepsis. Shortly after arrival, the patient suffered a cardiac arrest. Resuscitation attempts were unsuccessful. Antemortem blood testing revealed a salicylate concentration of 1055 mg/L (therapeutic range: 100–300 mg/L). Conclusion: This case highlights the potential for life-threatening systemic toxicity from topical salicylate use, particularly with prolonged application. Clinicians should maintain a high index of suspicion for salicylate poisoning in patients presenting with unexplained systemic symptoms and a history of topical product use.