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Letters to the Editor Indian Pediatrics 2002; 39:598-599 |
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Podophyllin Poisoning |
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Podophyllin is a resin mixture obtained from the dried Rhizome and roots of Podophyllin peltatum (North America) and Podopyllin emodi (India)(1). This resin contains atleast 16 chemicals including podophyllotoxin, alpha and beta peltatin, desoxypodophyllotoxin and quercetin. Of these, the toxic agent is thought to be Podophyllotoxin, a lipid soluble compound that crosses cell membranes with ease. This substance and its derivatives have a colchicine like effect, arresting the mitotic spindle(2). Neurotoxicity may be related to its in-vitro ability to bind microtubular protein and inhibit axoplasmic flow(2). Podophyllin has been used for external application in treatment of anogenital warts, condyloma accuminatum, malignancy basal cell epitheliomas, wet and exudative types of eczema and molluscum contagiosum(1). Podophyllin poisoning following both topical application and oral consumption has been reported in adults(1,3). There is a case report of Podophyllin toxicity in a child aged 2 years in western literature(2). There is no reported case in children in the Indian literature; hence we report a case of accidental consumption of podophyllin in a 2 year old girl. A 2-year-old female child was admitted with history of accidental administration of 1 tsf of Podwart (20% Podophyllin for topical application) following which, the patient had bouts of vomiting, convulsions and altered sensorium. Patient had fever and cough for which PARAMET syrup (Paracetamol + Metacloropromide) was prescribed but by mistake, Podowart was dispensed which was administered to the child by the parents. On examination at admission, the patient was in grade-III coma, febrile with respiratory rate of 56/min. Heart rate and blood pressure were normal. Neurological examination revealed no focal neurological deficit, pupils were normal in size and sluggishly reactive to light, fundus examination was normal and systemic examination was normal. In view of convulsions lumbar puncture was done and CSF analysis was normal. Chest X-ray done was normal. Liver function test done on day 4 of admission showed mild increase in enzymes while other parameters were normal. A diagnosis of accidential Podophyllin poisoning was made in view of history and examination. The patient was managed with symptomatic treatment, i.e., intravenous fluids, anticonvulsants, anti-edema measures and antipyretics. Convulsions subsided on 5th day after admission and the patient improved gradually in her sensorium over the next two weeks. She was discharged after four weeks of hospital stay. Local side effects reported following topical application of Podophyllin include erythema, edema, chemical burns and allergic sensitivity. Following systemic toxicity, nausea, vomiting, respiratory stimulation, peripheral neuropathy, fever, acute confusional states, tachycardia, oliguria, adynamic ileus, leukopenia, elevation of liver enzymes, coma and death have been reported(1). In this case, the child was administered Podophyllin orally due to the mistate in dispensing, and the child developed convulsions and coma, which recovered with symptomatic treatment without any sequelae. Sudha Rudrappa, L. Vijaydeva, Department of Pediatrics, Government Medical College, Mysore, India. |
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