Bilateral Optic Atrophy Following Methanol Poisoning: A Case Report: Neuro Ophthalmology

Onua A.A; Nwadiuto I.C; Pedro-Egbe CN

Authors

Onua A.A Department of Ophthalmology, University of Port Harcourt Teaching Hospital, P.M.B.6173, Port Harcourt, Nigeria.
Nwadiuto I.C Epidemiology Unit, Rivers State Ministry of Health, Port Harcourt, Nigeria.
Pedro-Egbe CN Department of Ophthalmology, University of Port Harcourt Teaching Hospital, P.M.B.6173, Port Harcourt, Nigeria.

Abstract

Background: In Nigeria, in May 2015, outbreak of methanol poisoning was reported in Rivers State. We hereby report one of the cases.

Case Report: A 53-year old man presented to the ophthalmology clinic, University of Port Harcourt Teaching Hospital on account of sudden loss of vision in both eyes, following consumption of a substance believed to be alcohol eight days before presentation. The patient said that he had consumed about 400ml of illicit gin popularly called “ogogoro” with five of his friends in Woji town, a suburb of Port Harcourt. The estimated quantity of ogogoro consumed by his friends was 500- 600ml each. The friends took ill after consuming the said product and died within 5-24 hours. The index patient developed vomiting, headache and diminution of vision about2-3 hours after consumption of the toxic product. Past ocular and medical history were not contributory. There was no history of glaucoma or blindness in the family. On ocular examination the visual acuity was Hand Motion (HM) in both eyes. The pupils were idely dilated and there was no reaction to in both eyes. Fundoscopy showed bilateral optic atrophy and this was confirmed by fundus photography. Laboratory investigations revealed normal complete blood count, fasting blood sugar, renal and hepatic functions. Arterial Blood Gas (ABG) analysis revealed metabolic acidosis with a pH of 7.16, pCO2 -16.2mmHg, HCO3 -6.1 meq/L, Na+- 146 meq/L, K+- 4.1meq/L and Cl- -110.9 meq/L. In view of suspicion of illicit toxic alcohol ingestion, epidemiological report of methanol poisoning outbreak in Rivers State, acute visual loss, metabolic acidosis and fundus photographic findings, the clinical diagnosis of methanol poisoning was entertained which met the diagnostic criteria listed in Table 1. The patient refused hospital admission because of financial constraints. He was however treated with sodium bicarbonate, folic acid, hydroxocobalamin, prednisolone and multivitamin tablets and advised to eat a well-balanced diet and abstain from drinking alcoholic beverages and smoking cigarettes. Patient was however lost to follow up so we do not know if there was any improvement in vision

Views | Downloads: 33 / 21

References

Givens M, Kalbfleisch K and Bryson S. Comparison of methanol exposure routes reported to Texas poison control centers. West J Emerg Med, 2008; 9(3): 150–153.

Kumar SS, Boopathy KS, Bhaskar ME. Methanol Poisoning – A Chennai Experience. J Assoc Physicians India 2003;51: 425-426.

Barceloux DG, Bond GR, Krenzelok EP, et al. American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning. J Toxicol Clin Toxicol 2002;40:415-446.

Fontenot AP and Pelak VS. Development of neurologic symptoms in a 26-year-old woman following recovery from methanol intoxication. Chest, 2002; 122(4): 1436– 1439

Shukla M, Shiroh I, Saleem A. Intravenous Methylprednisolone could salvage vision in Methyl alcohol Poisoning. Indian J Ophthamol 2006; 54: 68-69.

Fein DM and Y-J Sue. Methanol ingestion. Pediatr Rev, 2011; 32(12): 549–550.

Kruse JA. Methanol and ethylene glycol intoxication. Crit Care Clin, 2012; 28(4): 661–711.

Trivedi TH, Yeolekar ME, Shejale SB. Methanol poisoning in medical intensive care unit. J Assoc Physicians India 2001;49: 257-258.

Shah S, Pandey V, Thakore N, Mehta I. Study of 63 Cases of Methyl Alcohol Poisoning (Hooch Tragedy in Ahmedabad). J Assoc Physicians India 2012; 60: 34-36.

Nand L, Chander S, Kashyap R, Gupta D, Jhobta A. Methyl Alcohol Poisoning: A Manifestation of Typical Toxicity and Outcome. Journal of he association of physicians of india. 2014; 62: 756-759.