Haemolytic toxicity due to domestic naphthalene ball exposure in a glucose-6-phosphate dehydrogenase deficiency patient

Abstract

Naphthalene is a natural component of fossil fuels such as petroleum, diesel, and coal. is used widely as moth repellent,  insecticides and as a deodorant in lavatories worldwide. It is it is a toxic ,volatile, forming an inflammable vapour and sublimes at room temperature, producing its characteristic odour. This report presents a 29year-old male, Commercial tricycle driver, Ibo by tribe, Christian and single and was admitted with fatigue , severe abdominal pain , vomiting , yellowish coloration of the eyes and passage of dark urine (cocacola colored) following the use of  naphthalene ball for the purpose of repelling mosquitoes and other insects and as an air freshener for 5days .There was no history of similar illness in the past .There were features of severe   intravascular hemolysis ; elevated Lactate dehygrogenase enzymes (2320 IU/L) , elevated Bilirubin level (12.8mg/dl) , elevated Aspartate transaminase ;AST (71IU/L) and Alanine transaminase ;ALT (257IU/L) levels with decreased Hemoglobin (8mg/dl) and Haptoglobin (30mg/dl). Granulocytosis was also 143 detected. His Glucose 6 phosphate dehydrogenase (G6PD) activity  (1.5 IU/gm Hb) was found to be below normal and was diagnosed as G6PD  deficiency disorder. The patient was treated with bed rest, with adequate rehydration with intravenous fluid 3L/day, Antibiotics (Cefuroxime), Folic acid and fesolate and vitamin C and the mothballs in his room were removed before he was discharged home . The aim of this case report is to highlight the toxicity of this common  household naphthalene mothball especially in G6PD deficient patient.

Keywords: Intravascular hemolysis, Naphthalene moth ball, G6PD deficiency, Red blood cell.