Korean J Leg Med.  2017 Nov;41(4):137-140. 10.7580/kjlm.2017.41.4.137.

Death from Naphthalene Poisoning Manifesting as Toxic Hepatitis: An Autopsy Case

• Choi J
• Park SH
• Park MJ
• Jeon SH

• KMID: 2397688
• DOI: http://doi.org/10.7580/kjlm.2017.41.4.137

Abstract

Suicide through naphthalene poisoning is rare. Prolonged hemolytic anemia and hemoglobinuria are typical symptoms of naphthalene poisoning. We report an unusual case of naphthalene poisoning. The decedent was an 87-year-old female who intentionally ingested over 5 g of naphthalene. After more than 5 hours, she was found in a drowsy state. During initial examination, hemoglobin level and urine test results were normal. Aspartate aminotransferase and alanine aminotransferase levels were elevated (854 and 1,197 U/L, respectively). Metabolic acidosis was found on arterial blood gas analysis. The patient was treated conservatively by administration of activated charcoal, calcium gluconate, insulin, and glucose. However, the patient died after 1 day of hospital admission. On autopsy, the liver showed toxic hepatitis with confluent necrosis. Naphthalene concentrations in the blood and gastric contents were 5.4 and 5.8 mg/L, respectively. In conclusion, the decedent ingested naphthalene and died due to liver failure without hemolysis.

Keyword

Toxic hepatitis; Naphthalenes; Autopsy

MeSH Terms

Acidosis
Aged, 80 and over
Alanine Transaminase
Anemia, Hemolytic
Aspartate Aminotransferases
Autopsy*
Blood Gas Analysis
Calcium Gluconate
Charcoal
Drug-Induced Liver Injury*
Female
Glucose
Hemoglobinuria
Hemolysis
Humans
Insulin
Intention
Liver
Liver Failure
Naphthalenes
Necrosis
Poisoning*
Suicide
Alanine Transaminase
Aspartate Aminotransferases
Calcium Gluconate
Charcoal
Glucose
Insulin
Naphthalenes

Figure

• 

  Fig. 1. Microscopic finding of liver and kidney. Liver; toxic hepatitis. (A) Perivenular necrosis (zone 3 necrosis) with preserved hepatocytes around portal tracts (H&E, ×40). (B, C) Coagulative-type necrosis of hepatocytes, cholestasis, and congestion (B, H&E, ×200; C, H&E, ×400). (D) Kidney: autolysis without inflammatory reaction and pigment casts (H&E, ×400).

Reference

1.Hoffman RS., Howland MA., Lewin NA, et al. Goldfrank's toxicologic emergencies. 10th ed.New York: McGraw-Hill;2015. p. 1308–11.

2.Aliyu I., Ibrahim ZF. Haemolytic anemia and mothball toxicity: a case report. Sifa Med J. 2014. 1:39–41.

3.Annamalai KC., Shrikirarn A., Mundkur SC, et al. Acute naphthalene toxicity presenting with metabolic acidosis: a rare complication. J Acute Dis. 2012. 1:75–6.

4.Tang KY. A patient presented with dark brown urine after mothballs powder ingestion. Clin Toxicol (Phila). 2017. 55:674–5.

5.Chauhan V., Sharma R., Sharma K, et al. Naphthalene poisoning manifesting as hemoglobinuria. Toxicol Int. 2014. 21:314–5.

6.Lim HC., Poulose V., Tan HH. Acute naphthalene poisoning following the non-accidental ingestion of mothballs. Singapore Med J. 2009. 50:e298–301.

7.U.S. EPA. IRIS toxicological review of naphthalene (1998 Final). Washington, DC: U.S. Environmental Protection Agency;1998.

8.Ijiri I., Shimosato K., Ohmae M, et al. A case report of death from naphthalene poisoning. Nihon Hoigaku Zasshi. 1987. 41:52–5.