Chemical Necrotising Fasciitis Secondary to Self-Injection of Permethrin Insecticide

We report a 65-year-old male with chemical necrotising fasciitis after self-injection of permethrin insecticide. The patient also developed persistent hypoglycemia secondary to massive insulin overdose. There was no evidence of systemic toxicities from the insecticide poisoning. Multiple debridement and skin grafting were performed over his right forearm due to extensive tissue damage. He eventually recovered with impairment of his right hand function. The clinical features and the management of this uncommon route of insecticide poisoning are discussed. (Hong Kong j.emerg.med. 2011;18:441-445)

[1]  R. R. Jones,et al.  Parenteral administration of hydrocarbons. , 1984, Journal of toxicology. Clinical toxicology.

[2]  D. N. Bateman.  Management of Pyrethroid Exposure , 2000, Journal of toxicology. Clinical toxicology.

[3]  B. Childers,et al.  Soft tissue injection of hydrocarbons: a case report and review of the literature. , 1999, The Journal of emergency medicine.

[4]  A. Bacakoglu,et al.  Chemical necrotizing fasciitis due to household insecticide injection: is immediate radical surgical debridement necessary? , 2002, Human & experimental toxicology.

[5]  H. Weitz,et al.  Injection of household spray insecticide. , 1982, Annals of emergency medicine.

[6]  M. Limacher,et al.  Chemical pneumonitis after the intravenous injection of hydrocarbon. , 1978, Radiology.

[7]  Kwok-Leung Tsui,et al.  A Case of Acute Insulin Poisoning , 2006 .

[8]  L. Dosemeci,et al.  Systemic Organophosphate Poisoning following the Percutaneous Injection of Insecticide , 2002, Skin Pharmacology and Physiology.

[9]  M. Buchman.  Upper extremity injection of household insecticide: a report of five cases. , 2000, The Journal of hand surgery.

[10]  S. Kuschner,et al.  Insecticide injection injuries to both hands: a case report. , 1992, The Journal of hand surgery.

[11]  J. A. Vale,et al.  Poisoning due to Pyrethroids , 2005, Toxicological reviews.

[12]  N. Tabrizi,et al.  Surgical approach to hydrocarbon injection in upper extremities: case series. , 2009, International journal of surgery.

[13]  W. Burnham,et al.  Local excision of subcutaneous fat in the management of insulin overdose , 1986, The British journal of surgery.