Republished: Infant with status epilepticus secondary to systemic lidocaine toxicity from topical application.

In conjunction with BMJ Case Reports , DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years. A previously healthy 11-month-old infant presented to the emergency department in status epilepticus. There was no clear trigger of her seizure activity which resolved with benzodiazepines and fosphenytoin. On further review, her parents disclosed that she had been prescribed topical 4% lidocaine cream for a groin rash and was ultimately diagnosed with lidocaine toxicity in the emergency department. She was monitored in the intensive care unit without cardiovascular abnormalities or recurrence of seizure activity. Emergency medicine providers must maintain a broader differential of status epileptics and be able to recognise and manage potential complications from systemic lidocaine toxicity. Status epilepticus is a common presentation to paediatric emergency departments with the potential for significant morbidity and mortality, including the need for intubation, intensive care unit (ICU) admission, persistent neurological deficits and mortality in 3%–5% of children.1 Emergency department providers are responsible for maintaining a broad differential of undifferentiated status epilepticus (eg, infections, trauma, electrolyte derangements, epilepsy, inborn errors of metabolism, toxins/ingestions) as well as evaluating and treating reversible causes.2 Although systemic lidocaine toxicity is a known complication of local or parental administration, it is less commonly associated with topical application, especially among infants.3–6 We present a case of an infant who developed status epilepticus secondary to systemic lidocaine toxicity from local application to treat a diaper rash. A previously healthy 11-month-old infant presented to the emergency department for first time seizures in status epilepticus. Prior to presentation, she had been well other than …