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

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.