A Homeopathic Disaster: Case Report of Turpentine Toxicity (P4.399)

Abstract

Background: Turpentine toxicity is not well known and only a handful of case reports are published. Turpentine is used by some as homeopathic treatment of intestinal parasites. Turpentine is very dangerous and can result in serious complications including multiorgan failure, encephalitis, and death. Case Presentation: 48 year old male with a past medical history of Grave’s disease, ocular myasthenia gravis, ITP, chronic diarrhea and a recent diagnosis of extra-pontine myelinolysis, who presented with four days of fever, vomiting, and diarrhea. Patient was transferred from another hospital where he was admitted with these symptoms and found to have a serum sodium of 106. Patient’s sodium was rapidly corrected which resulted in the development of rigidity and tremors with bilateral basal ganglia T2 hyperintensities on MRI confirming extra-pontine myelinolysis. Upon transfer, patient became obtunded and hemodynamically unstable. Infectious, metabolic, and endocrine etiologies were thoroughly evaluated but work-up was negative. Laboratory values were significant for thrombocytopenia, hypolipoproteinemia, and depressed levels of complement. It was not until a nurse saw the patient’s brother giving the patient homeopathic medications that we learned of his ingestion of turpentine and determined its likely role in our patient’s condition. Conclusions: Turpentine is obtained from the distillation of tree resin. It is used topically for treatment of lice, or orally for intestinal parasite eradication. In research, turpentine is used in animal models to induce systemic inflammation by up-regulating pro-inflammatory cytokines. It is also found to substantially reduce cholesterol. Toxicity results in gastroenteritis, kidney failure, respiratory failure, hemodynamic instability, encephalitis and coma. We propose that patient’s acute illness was secondary to turpentine toxicity and likely contributed to patient’s autoimmune co-morbidities given its association of inducing a pro-inflammatory state. It is very important to obtain history of homeopathic medications and educate the community about the risks involved with unregulated medications.

Disclosure: Dr. MacCallum has nothing to disclose. Dr. Towfighi has nothing to disclose.