A case of suicidal poisoning with paraphenylenediamine (PPD) is reported. The patient presented with typical features of severe oropharyngeal oedema and rhabdomyolysis, He suffered sudden cardiac death within 4 hours of admission despite full supportive treatment. The diagnosis was only established after his death. Systemic poisoning with paraphenylenediamine (PPD) is rare in western countries, and therefore a high degree of awareness and circumstantial evidence is required to make an early diagnosis. The classical and other less commonly reported features of this poisoning are discussed. There is no specific antidote available but some guidelines for management of such a case are reviewed.
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References
1.
Edwards EK Jr & Edwards EKContact-urticara and allergic dermatitis caused by paraphenylenediamine. Cutis1984; 34: 877-88.
2.
Silberman DE & Sorrell AHAllergy in fur workers with special reference to paraphenylenediamine. Journal ofAllergy1959; 30: 1118.
3.
Fisher AAIs hair dyed with paraphenylenediamine allergenic?Contact Dermatitis1980; 6: 266.
4.
Munday R. & Manns E.Muscle necrosis by N-methylated paraphenylene-diamine in rats: structure-activity relationships and correlation with free radical production in vitro. Toxicology1989; 57: 303-14.
5.
Averbukh A., Modai D. & Leonov Y.Rhabdomyolysis and acute renal failure induced by paraphenylenediamine. Human Toxicology1989; 8: 345-8.
6.
Saito-K., Murai T., Yabe K. & Hara M.Rhabdomyolysis due to paraphenylenediamine (hair dye) - report of an autopsy case. Nippon-Hiogaku-Zasshi1990; 44: 469-74.
7.
Chugh KS, Malik GH & Singhal PC: Acute renal failure following paraphenylenediamine (hair dye) poisoning: Report of 2 cases. Journal of Medicine1982; 13: 131-7.
8.
Yagi H., El Hind AM & Khalil SI. Acute poisoning from hair dye. East African Medical Journal1991; 68: 404-11.
9.
Suliman SM, Homeida M. & Aboud OIParaphenylenediamine induced acute tubular necrosis following hair dye ingestion . Human Toxicology1983; 2: 633-5.
10.
El-Ansay EH , Ahmed Mek & Clague HWSystemic toxicity of paraphenylenediamine . Lancet1983; i: 1341.
11.
Bourquia A., Jarbrane AJ, Ramadani B. & Zaid D.Systemic toxicity of paraphenylenediamine. Presse Medicale1988; 17: 798.
12.
Hashim M., Hamza YO, Yahia B., Khogali FM & Suileman GIPoisoning from henna dye and paraphenylenediamine mixtures in children in Kartoum. Annals of Tropic Paediatrics1992 ; 12: 3-6.
13.
McCafferty LK. Hair dyes and their toxic effect. Archives ofDermatology and Syphilology1926; 14: 136.
14.
Goldberg BJ, Herman FF & Hirata RNSystemic anaphylaxis due to an oxidation product of p-phenylenediamine in a hair dye. Annals of Allergy1987; 58: 205-8.
15.
Ames BN, Kammen HO & Yamasaki E.Hair dyes are mutagenic: Identification of a variety of mutagenic ingredients . Proceedings of the National Academy of Sciences of the USA1975; 72: 2423-7.
16.
Nott HWSystemic poisoning by hair dye. The British Medical Journal1924; 1: 421-2.
17.
Gleason MN, Gosselin RE & Hodge HCClinical Toxicology of Commercial Products. Baltimore, Williams & Wilkins, 1963.
18.
Tainter ML, James M. & Vendeveuter W.Comparative edemic actions of ortho, meta and paraphenylenediamine in different species. Archives Internationales de Pharmacodynamie et de Therapie1929; 36: 152.
19.
Lubash GD, Philips RE, Schields JD & Bonsnes RWAcute anilure poisoning treated by hemodialysis. Archives ofInternal Medicine1964; 114: 530.
20.
Schreiner GE & Maher JPToxic nephropathy. American Journal of Medicine1965; 38: 409.
21.
Gonzales TA, Vance M. & Helpern M.Legal Medicine, Pathology and Toxicology, 2nd edition. New York, Appleton-Century-Crofts , 1954; 810.
22.
Graubarth J. , Bloom CJ, Coleman FC & Solomon HNDye poisoning in nursery. Journal of American Medical Association1945; 128: 1155.
23.
Rook A., Wilkinson DS, Ebling FJTextbook of Dermatology. Oxford, Blackwell Scientific Publications, 1969.
24.
Muehrcke RCAcute Renal Failure: Diagnosis and ManagementSt. Louis , CV Mosby Co., 1969, 211.
25.
Flink EBBlood transfusion studies. Relationship of haemoglobinemia and of the pH of urine to renal drainage produced by injection of hemoglobin solution into dogs. Journal of Laboratory and Clinical Investigations1954; 33: 825.
26.
Beerman H., Krishbaum BA, Criep LHAdverse Drug Reactions. Dermatologic Allergy: Immunology, Diagnosis, Management, First edition, edited by Criep LH.Philadelphia, W.B.Saunders Co., 1969, p208.
27.
O'Brien, PJMultiple mechanisms of metabolic activation of aromatic amine carcinogens. Free Radicals in Biology, vol VI. New York, Academic Press, 1984; pp. 289-322.
28.
Israels MBSystemic poisoning by phenylenediamine. The Lancet1934i; 508-10.
