Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2022; 10(19): 6571-6579
Published online Jul 6, 2022. doi: 10.12998/wjcc.v10.i19.6571
Acute methanol poisoning with bilateral diffuse cerebral hemorrhage: A case report
Jin Li, Zhi-Juan Feng, Lei Liu, Yu-Jie Ma
Jin Li, Zhi-Juan Feng, Lei Liu, Yu-Jie Ma, Department of Critical Care Medicine, Air Force Medical Center, PLA, Beijing 100142, China
Author contributions: Li J contributed to case summary and wrote the paper; Feng ZJ contributed to the table and figure management; Liu L contribute to the literature search and induction; Ma YJ contribute to the core argument of this case; all authors revised the paper and approved the submitted version.
Informed consent statement: The patient's family provided informed written consent prior to the case report.
Conflict-of-interest statement: There is no conflict-of-interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-Jie Ma, MD, Associate Chief Physician, Department of Critical Care Medicine, Air force Medical center, PLA, No. 30 Fucheng Road, Haidian District, Beijing 100142, China. yujma@126.com
Received: October 29, 2021
Peer-review started: October 29, 2021
First decision: March 23, 2022
Revised: April 4, 2022
Accepted: May 5, 2022
Article in press: May 5, 2022
Published online: July 6, 2022
Abstract
BACKGROUND

Acute methanol poisoning (AMP) is a systemic disease that mainly affects the central nervous system and is characterized by ocular damage and metabolic acidosis. If appropriate treatments are inadequate or delayed, the mortality can exceed 40%. As the most serious complication, cerebral hemorrhage is rare with reported prevalence of 7%-19%.

CASE SUMMARY

A 62-year-old man drank liquor mixed with 45% methanol and 35% alcohol. His vision blurred 10 h later and he fell into coma in another 9 h. Serum toxicological tests were performed immediately, and continuous renal replacement therapy (CRRT) was carried out as the lactic acid exceeded 15 mmol/L and blood pH was 6.78. In addition, the toxicological report revealed 1300.5 μg/mL of methanol in serum and 1500.2 μg/mL in urine. After 59 h of CRRT, the methanol level decreased to 126.0 μg/mL in serum and 151.0 μg/mL in urine. However, the patient was still unconscious and his pupillary light reflex was slow. Computed tomography showed hemorrhage in the left putamen. After 16 d of life support treatment, putamen hemorrhage developed into diffuse symmetric intracerebral hemorrhage. In the end, his family gave up and the patient was discharged, and died in a local hospital.

CONCLUSION

Cerebral hemorrhage requires constant vigilance during the full course of treatment for severe cases of AMP.

Keywords: Acute methanol poisoning, Cerebral hemorrhage, Toxicity, Hemodialysis, Case report

Core Tip: We describe a case of a 62-year-old man who drank liquor mixed with 45% methanol and 35% alcohol, and the serum methanol level was almost 2.6 times that of the recommended indication for hemodialysis even at 24 h after drinking. It was encouraging that his vital signs tended to be stable and methanol level dropped sharply at 48 h after hemodialysis and necessary life support treatment. Unfortunately, putamen hemorrhage occurred 16 d after the treatments and progressed to bilateral symmetric diffuse cerebral hemorrhage. His family gave up further treatment, and the patient died eventually.