[Tako-Tsubo syndrome associated with acute carbamate poisoning in Tunisia: a rare, multifactorial cardiac complication].

摘要

INTRODUCTION: Poisoning by carbamate-type anticholinesterase insecticides can result in severe clinical symptoms involving the gastrointestinal, respiratory, and neurological systems. Here, we present a rare case of Tako-Tsubo syndrome (TTS) that occurred in Tunisia alongside severe intentional poisoning by this type of insecticide. CASE REPORT: An 18-year-old female patient was admitted to the intensive care unit in a coma after intentionally ingesting methomyl. She initially presented with cholinergic symptoms. On the second day, she went into shock and had a seizure. Echocardiography revealed hypokinesis of the basal segments and impaired global longitudinal strain, which is suggestive of reverse TTS. Laboratory tests showed elevated troponin and NT-proBNP levels, which supported the diagnosis. A follow-up echocardiogram 48 hours later showed complete recovery of cardiac function. The patient survived without sequelae. DISCUSSION: TTS following carbamate poisoning may result from a triad of coronary spasm, direct myocardial toxicity due to oxidative stress, and excessive sympathetic stimulation, which explains the acute ventricular dysfunction. CONCLUSION: This case illustrates the possible involvement of carbamates in the pathogenesis of TTS via a multifactorial mechanism combining autonomic imbalance and endothelial damage. The case underscores the need for increased vigilance and the critical role of echocardiographic strain in refining diagnosis and guiding management.