An interesting case of Nitrobenzene poisoning

Nitrobenzene compound, is commonly used in the solvents, pesticides, and dyes. Its consumption produces symptoms of increased secretion, respiratory muscle weakness due to methemoglobinaemia. Here we report a case of 45 years male admitted with consumption of unknown pesticide with symptoms of increased salivation, respiratory muscle weakness and cyanosis. Immediately he was intubated and connected to ventilator. In spite of the good ventilator support his saturation did not improve and the blood sample collected for the routine investigation was chocolate brown colored. We suspected Methemoglobinaemia and estimated the methemoglobin level and it was very high. We treated with I.V Methylene blue, multiple exchange blood transfusions, parenteral ascorbic acid, and alkaline diuresis. Patient dramatically improved and survived. Later the poison was identified as pesticide powder containing Nitrobenzene compound and it will produce symptoms like Organophosphorus compounds (OPC). Our presentation highlights the importance of an uncommon poisoning which presents like OPC, where careful elicitation of history and high degree of suspicion about the Methemoglobinaemia is necessary for timely intervention and management.