ORGANOPHOSPHORUS INDUCED DELAYED NEUROPATHY (OPIDN); TYPE III PARALYSIS PRESENTING 3 WEEKS AFTER THE INITIAL ORGANOPHOSPHORUS EXPOSURE

SUMMARY
Organophosphates are carbon and phosphate
containing compounds that are potent inhibitors of the
enzyme acetylcholinesterase which normally degrades
acetylcholine. This results in an excess of acetylcholine
which can trigger cholinergic toxicity. Organophosphate
poisoning can be classified into 3 types based primarily
on their symptoms and timeline of their appearance.
Type I paralysis or cholinergic syndrome which occurs
within hours is due to the excessive stimulation of nicotinic
receptors by acetylcholine. Type II paralysis or
intermediate syndrome usually appears 24 to 96 hours
after poisoning. The clinical features are muscular weakness
affecting predominantly the proximal muscles and
neck flexors. The weakness starts from ocular muscles
and spread towards the muscles of head and neck
and then the proximal limb and respiratory muscles.
Type III paralysis or organophosphate induced delayed
neuropathy (OPIDN) is a pure motor or predominantly
motor axonal neuropathy characterized by flaccid limb
paralysis with minimal or no sensory loss, which occurs
2-3 weeks after exposure to an organophosphate agent.
Here we are presenting the case of a 30 years old female
who presented with progressive lower and then
upper limb weakness and paresthesias, 3 weeks after
her initial exposure