A 14-year-old previously healthy adolescent presented four generalized tonic-clonic seizures over a period of about 30 minutes after dinner, associated with vomiting and transient loss of consciousness; two hours later she suffered diazepam in a hospital.
The patient was febrile and hypoxemic; a chest X-ray revealed bilateral pulmonary infiltrates; a gastric lavage was performed with negative result and was referred to our hospital.
The interview was negative for an infectious prodrome, cough, stridor, hemoptysis, dysphagia, toxic or drug intake, contact with rodents and insects and previous seizures.
Upon admission the patient was alert with a Glasgow coma scale score of 15/15, well perfused and without edema.
His vital signs were 48 breaths per minute, 122 beats per minute, blood pressure 110/70 mmHg, axillary temperature 38.2oC, transcutaneous oxygen mask 93%, and breath therapy 40% per minute.
Physical examination revealed crusted lesions without flogosis in the right foot of one week of evolution; there was nasal flaring and diffuse rales in both lungs; the rest of the physical examination was normal.
The laboratory revealed neutrophilic leukocytosis: 22,000 white blood cells/mm3 and mild metabolic acidosis: bicarbonatemia 20.9 mEq/L; the rest of the blood and urine analyses were normal.
A chest X-ray showed diffuse bilateral pulmonary infiltrates without pleural effusion and normal cardiac silhouette ; electroencephalogram, electrocardiogram and echocardiogram showed no abnormalities.
Subsequently, he received cefotaxime, vancomycin, clindamycin; intravenous furosemide was administered every 6 h (100 mg/day in total), water intake was restricted to undetectable losses by mask.
In the following 48 h there was a significant clinical improvement with radiological normalization, antibiotic therapy was suspended.
In a new interrogation, the patient introduced the ingestion of an insect as attempted suicide after a family discussion.
Liquid poisoning was identified at home.
Median chromatography in layer detected organochlorine (no specific compound was identified); the result was negative for blood and urine samples.
The patient was discharged on the fourth day of hospitalization in good health.
