Unusual case of severe arrhythmia developed after acute intoxication with tosylchloramide

After accidental ingestion of tosylchloramide a caucasian 77-year-old woman, with a family history of cardiovascular disease and hypertension, was admitted to the intensive care unit following episodes of torsades de pointes with a prolonged QT/QTc interval (640/542 ms). The patient received an implantable cardioverter-defibrillator, was discharged from the hospital with normal QT/QTc interval and did not experience additional ventricular arrhythmias during one year of follow-up.This is the first report concerning an unusual case of torsades de pointes after accidental intoxication by ingestion of tosylchloramide. The pronounced impact of the oxidyzing agent tosylchloramide on the activity of some of the ion channels regulating the QT interval was identified as a probable cause of the arrhythmia.Because of its high activity against fungi and bacteria, tosylchloramide is a widely used disinfectant agent for common applications such household cleaning and swimming pool disinfection. Many case reports describing tosylchloramide intoxication have been already published in the past showing that the chronic exposure to this compound may cause hypersensitivity reactions, such as asthma [1,2], conjunctivitis [3], whereas toxic pneumonitis [4], cardiovascular collapse and myocardial damage may occur in acutely intoxicated patients [5]. Here we report the first case of a severe arrhythmia developed in the context of acute oral intoxication with tosylchloramide.A 77-year-old woman presenting shoulder girdle pain was admitted to our hospital with suspected coronary syndrome. She had a history of hypertension; treated since 5 years with Perindopril (5 mg once daily) and a family history of cardiovascular disease. Few hours after the admission at the Emergency Room (ER) the patient experienced a cardiac arrest due to a “Torsade de Pointes” (TdP) degenerated into ventricular fibrillation which required DC shock (200 J), as documented by electrocardiogram (ECG) (Figure 1). After sp