Zinc phosphide poisoning with unusual radiologic findings

Rodenticides comprise heterogeneous agents with distinctly different toxicity profiles. Metal phosphides such as aluminum phosphide and zinc phosphide (Zn3P2) are among the most potent rodenticides. In both humans and rodents, gastric acid reacts with phosphide to generate toxic phosphine gas, a highly lethal compound 1, 2. There are concerning anecdotal reports that ingestion of such agents to commit suicide has observed a growing trend during recent years in Iran. Among scarce reports on this topic available in the literature, only a single particular study reported 102 patients presented with this kind of poisoning to a single referral poisoning center in Tehran, Iran, during a 3.5‐year retrospective study period 3. However, this presentation is not limited to Iran. As these rodenticides are cheap, they are extensively used, especially in developing countries, and several reports have described mortalities as a result of accidental or suicidal ingestion of such compounds, especially in the 1990s in India. Poisoning with metal phosphides has been described as the most prevalent cause of poisoning in rural areas of Northern India 4. Besides, this poisoning has been reported from other countries such as South Africa 5, France 6, Mexico 7, and many other areas. Many characteristic clinical and laboratory properties of metal phosphide poisoning have been described in toxicology and forensic medicine journals. But, to date, no clinico‐radiologic correlation of such patients has been published. In previous reports of zinc phosphide poisoning, some important radiographic findings, such as radiopaque nature of the substance, and imaging findings pointing to pulmonary and abdominal complications of intoxication have been described 3, 8. Here, we will describe some new radiological features in a patient with zinc phosphide poisoning. The constellation of clinic‐radiologic findings described here has not been reported previously in the literature. In our opinion, knowledge of these new findings would help the emergency physicians or toxicologists/radiologists for earlier diagnosis of this usually lethal intoxication and more immediate planning for accurate therapeutic interventions.