Acute fluoroacetamide poisoning with reversible leukoencephalopathy: A case report and literature review highlighting the effectiveness of acetamide and the diagnostic value of neuroimaging.

RATIONALE

Acute fluoroacetamide poisoning is a rare and life-threatening emergency. Diagnosis is challenging due to nonspecific symptoms and a latent period. This report emphasizes the effectiveness of delayed acetamide treatment and the importance of neuroimaging for diagnosis and monitoring.

PATIENT CONCERNS

A 58-year-old man was admitted to the emergency room about 5 hours after intentionally ingesting an unknown pesticide following a personal conflict.

DIAGNOSES

Fluoroacetamide poisoning was initially suspected based on prior domestic case reports, the patient history of pesticide ingestion, clinical signs, and diffusion-weighted magnetic resonance imaging (MRI) showing characteristic features of cytotoxic edema in specific brain regions. Upon confirming the pesticide product with the seller, the diagnosis was ultimately confirmed as fluoroacetamide poisoning.

INTERVENTIONS

Gastric lavage, intramuscular acetamide, fluid resuscitation, and electrolyte correction were administered.

OUTCOMES

The patient showed rapid clinical improvement after receiving acetamide. He was discharged after one week without any additional medication. Follow-up MRI at one month showed complete resolution of the previous abnormalities, and he reported no symptoms at the one-year follow-up.

LESSONS

This case highlights the potential advantages of delaying acetamide treatment and suggests that brain diffusion-weighted MRI could be valuable in diagnosing and monitoring acute fluoroacetamide poisoning.

Copyright © 2026 the Author(s). Published by Wolters Kluwer Health, Inc.