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    Acute Obstructive Fibrinous Lanryngotracheobronchitis Induced by Severe Glyphosate Surfactant Intoxication. A Case Report - Yang & Lu - 2020

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    Acute Obstructive Fibrinous Lanryngotracheobronchitis Induced by Severe Glyphosate Surfactant Intoxication. A Case Report - Yang & Lu - 2020

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    Acute obstructive fibrinous lanryngotracheobronchitis induced by severe glyphosate surfactant intoxication. A case report - Yang & Lu - 2020

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    Acute Obstructive Fibrinous Lanryngotracheobronchitis Induced by Severe Glyphosate Surfactant Intoxication. A Case Report - Yang & Lu - 2020

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    World J Emerg Med, Vol 11, No 2, 2020 125

    Case Letter

    Acute obstructive fibrinous laryngotracheobronchitis


    induced by severe glyphosate surfactant intoxication:
    A case report
    Feng-lu Yang1, Xiao Lu2
    1
    Hangzhou Emergency Center, Hangzhou 310010, China
    2
    Department of Emergency Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou
    310009, China
    Corresponding Author: Xiao Lu, Email: [email protected]

    World J Emerg Med 2020;11(2):125–126


    DOI: 10.5847/wjem.j.1920–8642.2020.02.012

    Dear editor, showed slight aspiration pneumonitis in the ileus of


    Glyphosate is a nonselective herbicide commonly the intestine. The patient had no respiratory failure
    used in agriculture worldwide. Glyphosate targets the or shock after treatment, which inculded the gastric
    shikimate metabolic pathway, which is found in plants lavage and hemodiafiltration in the ED. She was
    but not in animals. Therefore, it is considered to be of then transferred to the intensive care unit (ICU) for
    low toxicity to humans, supported by the finding of further treatment. However, she experienced sudden
    high concentrations of oral and dermal LD50 (>5,000 hoarseness and shortness of breath in the middle of the
    mg/kg body weight) of glyphosate in experimental night after her second day’s treatment in the ICU. She
    animals. [1,2] Ingesting commercial formulations of had typical symptoms of upper-airway obstruction,
    glyphosate surfactant herbicide (GlySH), however, and the peripheral oxygen saturation (SpO2) decreased
    has been reported to be associated with various toxic to 70%–75%. The patient was immediately intubated
    effects, including gastrointestinal injury, laryngeal injury, and mechanically ventilated, but the SpO 2 remained
    impaired renal function, metabolic acidosis, arrhythmias, low (85%–90%) as the FiO2 was 100%, and the peak
    pulmonary toxicity, shock, and even death.[3] Recently, inspiratory pressure of mechanical ventilation exceeded
    glyphosate surfactant has been used with increasing 40 cmH2O, indicating possible airway obstruction. We
    frequency in suicide attempts, and clinical toxicologists examined her with the bronchoscope, and found large
    have encountered fatal cases of glyphosate surfactant numbers of hyperplasias in the pseudomembrane blocked
    poisoning. [4] Mortality from ingesting glyphosate the principal bronchus (Figure 1A). We tried to remove
    surfactant varies from 0% to 29.3%, depending on the hyperplasia from the bronchus but failed, because it
    patients’ characteristics such as age and intent of was too large and tightly attached. The patient underwent
    exposure. [5–7] Acute fibrinous laryngotracheobronchitis is
    often seen in infants and children, but it is rare in adults.
    Here we present a case with acute obstructive fibrinous
    laryngotracheobronchitis induced by severe glyphosate-
    surfactant intoxication.

    CASE A B C
    A 52-year-old woman ingested 250 mL of glyphosate Figure 1. Results of bronchoscope and pathological report. A: The
    surfactant in a suicide attempt and was admitted to the bronchus blocked by pseudomembrane; B: the pseudomembrane
    taken out under the bronchoscope; C: the pathological report of this
    emergency department (ED). CT scans of the chest hyperplasia showing the inflammatory lesion of tissues.

    © 2020
    2017 World Journal of Emergency Medicine www.wjem.com.cn
    126 Yang et al World J Emerg Med, Vol 11, No 2, 2020

    emergency tracheotomy, and the main pseudomembrane tachycardia, elevated creatinine, and hyperkalemia are
    was taken out from the tracheostoma (Figure 1B). SpO2 poor prognostic factors if present. The reason for the
    increased to normal levels after these treatments, and we laryngotracheobronchitis in this patient was unclear, but
    removed more pseudo-membranes from the bronchus clinicians must be careful when treating patients with
    on the second day. The pathological report of this severe glyphosate-surfactant intoxication, even if they do
    hyperplasia showed the inflammatory lesion of tissues not initially have respiratory failure.
    (Figure 1C). Psychoanalyst was called for evaluating
    the mental problem of the patient and helping her with
    some psychotherapies. The patient left the hospital after Funding: None.
    2 weeks, with good prognosis. Ethical approval: Not needed.
    Conflicts of interest: There is no conflict of interest in this study.
    Contributors: FY proposed the study, and wrote the first draft. All
    authors read and approved the final version.
    DISCUSSION
    Glyphosate inhibits plant growth by interfering
    with the 5-enolpyruvylshikimate-3-phosphate synthase
    REFERENCES
    (EPSP), which is required for the production of aromatic 1 Tarazona JV, Court-Marques D, Tiramani M, Reich H, Pfeil R,
    amino acids. The precise mechanism underlying GlySH Istace F, et al. Glyphosate toxicity and carcinogenicity: a review
    inhibition is unclear. Damage to cellular components, of the scientific basis of the European Union assessment and its
    differences with IARC. Arch Toxicol. 2017;91(8):2723-43.
    including the mitochondria, cell membrane, and
    2 Roberts DM, Buckley NA, Mohamed F, Eddleston M, Goldstein
    deoxyribonucleic acid (DNA), and to protein synthetic DA, Mehrsheikh A, et al. A prospective observational study of
    machinery has been reported. However, evidence shows the clinical toxicology of glyphosate containing herbicides in
    that the surfactant coformulant, not the glyphosate adults with acute self-poisoning. Clin Toxicol. 2010;48(2):129-
    herbicide, is responsible for most of these effects. The 36.
    3 Garlich FM, Goldman M, Pepe J, Nelson LS, Allan MJ,
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    interfering with oxidative phosphorylation and cellular following a lifethreatening ingestion of glyphosate-surfactant
    energy production. [8] Toxicity symptoms differ from herbicide. Clin Toxicol. 2014;52(1):66-71.
    mild gastrointestinal discomfort to severe renal, 4 Lee CH, Shih CP, Hsu KH, Hung DZ, Lin CC. The early
    prognostic factors of glyphosatesurfactant intoxication. Am J
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    Emerg Med. 2008;26(3):275-81.
    is less toxic to humans than to plants, poisoning can 5 Ghannoum M, Bouchard J, Nolin TD, Ouellet G, Roberts
    be fatal.[9–11] Acute fibrinous laryngotracheobronchitis DM. Hemoperfusion for the treatment of poisoning:
    is common in infants and children but very rare in technology,determinants of poison clearance, and application in
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    looking blue. World J Emerg Med. 2019;10(4):251-2.
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    fibrinous laryngotracheobronchitis may have been caused outcome of the ingestion of glyphosate herbicide? Clin Toxicol
    by aspiration pneumonia or glyphosate surfactant, and (Phila). 2006;44(3):329-32.
    inflammatory lesions might have caused the cells of the 8 Stella J, Ryan M. Glyphosate herbicide formulation: a potentially
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    CONCLUSION Received July 10, 2019
    The toxicokinetics of glyphosate surfactant is
    Accepted after revision December 8, 2019
    complicated. Respiratory failure, metabolic acidosis,

    www.wjem.com.cn

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