| Disease | A CASE OF A MALE AGED 42 WHO WAS ADMITTED TO THE HOSPITAL NINE HOURS AFTER TAKING A TEASPOONFUL OF "LIQUOR EPISPASTICUS",WHICH HE KNEW CONTAINED CANTHARIDIN(CA. 20 MG),
WHICH HE BELIEVED WOULD INCREASE HIS LIBIDO,EVEN THOUGH HE HAD READ OF A MAN WHO HAD CAUSED THE DEATH OF TWO TYPISTS BY CONCEALING CANTHARIDES IN COCONUT ICE.
ONE HOUR AFTER TAKING THE MIXTURE SYMPTOMS STARTED WITH THE INCREASED FREQUENCY OF MICTURITION AND SEVERE DYSURIA. ABOUT TWO HOURS LATER HE FELT NAUSEATED AND VOMITED.
HE MICURATED 5 TIMES BETWEEN 9:00 AND 10:00 P.M., EACH SPECIMEN BECOMING PROGRESSIVELY MORE BLOOD-STAINED. HALF AN HOUR LATER HE WAS PASSING PURE BLOOD.
HE HAD ABDOMINAL DISCOMFORT ACCOMPANIED BY BOUTS OF DIARRHEA AND CONTINUED TO HAVE HEMATURIA AND DEVELOPED PRIAPISM, A FEW HOURS LATER HE BECAME WORRIED AND DECIDED TO SEEK MEDICAL ADVICE.
ON EXAMINATION HE WAS PALE AND EXTREMELY ANXIOUS. THERE WAS NO PYREXIA AND HIS BLOOD PRESSURE WAS 120/80. THE MUCOUS MEMBRANES AND THROAT WERE REDDENED,BUT BLISTERING WAS NOT EVIDENT.
GENERALIZED TENDERNESS WAS PRESENT OVER THE ABDOMEN AND THE BLADDER WAS PALPABLE. THE PENIS WAS ERECT AND BLOOD WAS PRESENT AT THE TIP OF THE URETHRA. THE CENTRAL NERVOUS, RESPIRATORY AND CARDIOVASCULAR SYSTEMS WERE NORMAL.
URINE WAS LOADED WITH PROTEIN (300 MG/ML) AND BLOOD WAS VISIBLE MACROSCOPICALLY,PUS,RED BLOOD AND SCANTY EPITHELIAL CELLS WERE SEEN ON MICROSCOPY. NO CASTS WERE PRESENT.
THE SUBJECT WAS TREATED WITH A HIGH FLUID INTAKE OF MILK, A MAGNESIUM SULFATE ENEMA, ANALGESICS AND SEDATION. THE NEXT DAY ULCERATION AND BLISTERING OF THE MUCOUS MEMBRANES OF BOTH CHEEKS, THE TONGUE AND PALATE WERE OBSERVED.
THESE RESPONDED WELL TO HYDROCORTISONE PELLETS. HIS BLOOD PRESSURE WAS MAINTAINED AND THE DAILY URINARY OUTPUT REMAINED AT CA. 2 LITERS PER 24 HOURS. THE PRIAPISM SUBSIDED SPONTANEOUSLY AND WITHIN FOUR DAYS THE URINARY ABNORMALITIES HAD RESOLVED.
WHEN SEEN AS AN OUTPATIENT ONE MONTH LATER HE WAS EXTREMELY FIT. HIS HEMOGLOBIN WAS 13.4 GM/100 ML AND SERUM UREA 35 MG/100ML AND HIS URINE SHOWED NO ABNORMAILITY.
THE PREPARATION WHICH CAUSED THESE MANIFESTATIONS (LIQUOR EPISPASTICUS) CONTAINED CANTHARIDIN (400 MG), CASTOR OIL (2.5 ML), COLOPHOMY (1.2 GM) PLUS ACETONE TO MAKE 100 ML. |