Department of Emergency and Critical Care Medicine, School of Medicine, Kitasato University, Minamiku, Sagamihara, 252-0374, Japan.
Clin Toxicol (Phila). 2011 Feb;49(2):118-20. doi: 10.3109/15563650.2011.552065.
The mechanisms underlying early central nervous system (CNS) signs and symptoms of glyphosate-surfactant herbicide (GlySH) poisoning are unclear.
A 58-year-old woman ingested approximately 150 mL of GlySH containing 41% glyphosate and 15% polyoxyethyleneamine. Two days later, she was admitted in the Emergency Center in a semicomatose state. Acute respiratory distress syndrome, circulatory collapse, acute renal failure, and disseminated intravascular coagulopathy were diagnosed. Meningitis was also suspected as she demonstrated Kernig's sign and significant neck stiffness with rigidity of the extremities as well as consciousness disturbance and fever (38.4°C). Investigations of cerebrospinal fluid (CSF) revealed the presence of glyphosate (122.5 μg/mL), significant elevation of IL-6 (394 μg/mL), and pleocytosis (32 cells/μL) with monocyte dominance. All bacteriological and virological tests were later found to be negative. She recovered completely after responding to aggressive supportive care in the intensive care unit. All signs and symptoms suggesting meningitis resolved as the concentration of glyphosate in CSF decreased. She was discharged on day 39 of hospitalization.
These findings suggest that the present case involved aseptic meningitis in association with GlySH poisoning.
CNS signs and symptoms induced by aseptic meningitis should be considered in cases of glyphosate-surfactant herbicide poisoning.
草甘膦-表面活性剂除草剂（GlySH）中毒早期中枢神经系统（CNS）体征和症状的机制尚不清楚。
一名 58 岁女性摄入了约 150 毫升含有 41%草甘膦和 15%聚氧乙烯胺的 GlySH。两天后，她处于半昏迷状态被收入急诊中心。诊断为急性呼吸窘迫综合征、循环衰竭、急性肾衰竭和弥漫性血管内凝血。由于她表现出 Kernig 征和四肢僵硬以及意识障碍和发热（38.4°C），还怀疑患有脑膜炎。对脑脊液（CSF）的检查显示存在草甘膦（122.5μg/mL），白细胞介素 6（IL-6）显著升高（394μg/mL），并伴有单核细胞优势的细胞增多症。后来所有的细菌学和病毒学检查均为阴性。她在重症监护病房接受积极的支持治疗后完全康复。随着 CSF 中草甘膦浓度的降低，所有提示脑膜炎的体征和症状均得到缓解。她在住院第 39 天出院。
这些发现表明，本例与 GlySH 中毒有关，涉及无菌性脑膜炎。
在草甘膦-表面活性剂除草剂中毒的情况下，应考虑无菌性脑膜炎引起的 CNS 体征和症状。
