A rare case of carbamate induced delayed neuropathy

Organophosphate compounds and carbamates are commonly used as insecticides in the agriculture and as petroleum additives, flame retardants and lubricants in industry. Organophosphate and carbamate poisoning can present as acute cholinergic crisis, intermediate syndrome or delayed neuropathy. Carbamates are reversibile inhibitors of acetylcholinesterases, and some also inhibit neuropathy target esterases (NTE), the target in organophosphate induced delayed neuropathy. Though carbamates are widely used, they are thought to be unable to initiate delayed neuropathy due to mechanistic considerations. Hence carbamate induced delayed neuropathy is only rarely reported in literature. We report a patient with carbamate poisoning, who had classic acute cholinergic crisis with subsequent development of delayed neuropathy. No definite treatment is available for delayed neuropathy and recovery is poor. We conclude that though it is rare, all patients with carbamate poisoning should be followed up for atleast four weeks for early identification of intermediate syndrome and delayed neuropathy.