A rare case of carbamate induced delayed neuropathy

Abstract

Organophosphate compounds and carbamates
are commonly used as insecticides
in the agriculture and as petroleum
additives, flame retardants and lubricants
in industry. Organophosphate and carbamate
poisoning can present as acute
cholinergic crisis, intermediate syndrome
or delayed neuropathy. Carbamates are
reversibile inhibitors of acetylcholinesterases,
and some also inhibit neuropathy
target esterases (NTE), the target
in organophosphate induced delayed
neuropathy. Though carbamates are
widely used, they are thought to be unable
to initiate delayed neuropathy due to
mechanistic considerations. Hence carbamate
induced delayed neuropathy is
only rarely reported in literature. We report
a patient with carbamate poisoning,
who had classic acute cholinergic crisis
with subsequent development of delayed
neuropathy. No definite treatment is
available for delayed neuropathy and recovery
is poor. We conclude that though
it is rare, all patients with carbamate poisoning
should be followed up for atleast
four weeks for early
identification of intermediate syndrome and
delayed neuropathy.