Fatal Multisystem Toxicity and Vesiculobullous Eruptions Following Brake Fluid Poisoning: A Case Report
International Journal of Medical Toxicology and Forensic Medicine,
Vol. 15 No. 4 (2025),
30 October 2025
,
Page 1-6
https://doi.org/10.22037/ijmtfm.v15i4.49459
Abstract
Background: Ethylene glycol and diethylene glycol, commonly found in automotive brake fluids, are highly toxic agents. While their nephrotoxic and neurotoxic effects are well documented, delayed and atypical systemic manifestations are less frequently reported.
Case Presentation: We describe a 53-year-old male who presented with acute epigastric pain after ingesting 50 mL of brake fluid. Initial assessment and laboratory findings were unremarkable. However, he returned 36 hours later with acute kidney injury, high-anion-gap metabolic acidosis, and worsening clinical status. Over the subsequent days, he developed progressive multi-organ failure, including hypoxemia, altered consciousness, optic disc edema, intraretinal hemorrhages, and visual impairment. By day seven, he demonstrated brainstem areflexia and diffuse cerebral edema, requiring intubation. Dermatomal vesiculobullous eruptions suggestive of viral reactivation and superinfected pressure ulcers. Despite hemodialysis and supportive treatment, he died on day 43 following cardiorespiratory arrest.
Conclusion: This case highlights rare, delayed manifestations of brake fluid poisoning, including optic neuropathy, dermatomal vesiculobullous eruptions, and progressive brainstem dysfunction. Such atypical features may delay diagnosis and complicate management. Brake fluid poisoning can present with evolving multisystem complications beyond the acute phase. Extended observation and a multidisciplinary approach are crucial, even in patients initially presenting with stable vital signs
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References
[1] Vadysinghe AN, Kumarasinghe WGGB, Kodikara S, Wickramasinghe N. Suicide by ethylene glycol/brake oil poisoning—a case report. Egyptian Journal of Forensic Sciences. 2021;11. [DOI:10.1186/s41935-021-00210-3]
[2] Osterhoudt KC. Chapter 134 - Toxic Alcohols. In: Baren JM, Rothrock SG, Brennan JA, Brown L, editors. Pediatric Emergency Medicine. Philadelphia: W.B. Saunders; 2008. p. 947-9. [DOI: 10.1016/B978-1-4160-0418-8.50038-5]
[3] Basnayake B, Wazil AWM, Nanayakkara N, Mahanama R, Premathilake PNS, Galkaduwa K. Ethylene glycol intoxication following brake fluid ingestion complicated with unilateral facial nerve palsy: a case report. J Med Case Rep. 2019;13(1):203. [DOI: 10.1186/s13256-019-2152-1]
[4] Sharma D, Sebastian R. Ethylene Glycol Poisoning Complicated by Cardiac Arrest and a Raised Lactate Gap: A Case Report. Cureus. 2025;17(2):e78743. [DOI: 10.7759/cureus.78743]
[5] Mullins ME, Kraut JA. The Role of the Nephrologist in Management of Poisoning and Intoxication: Core Curriculum 2022. Am J Kidney Dis. 2022;79(6):877-89. [DOI: 10.1053/j.ajkd.2021.10.006]
[6] Nahrir S, Sinha S, Siddiqui KA. Brake fluid toxicity feigning brain death. BMJ Case Rep. 2012;2012. [DOI: 10.1136/bcr-2012-006704]
[7] Rathnayaka RMMKN, Ranathunga PEAN. Acute Kidney Injury, Myocardial Infarction and Death Following Brake Fluid Poisoning; A Case Report. Asia Pacific Journal of Medical Toxicology. 2017;6(2):62- 6. [DOI: 10.22038/apjmt.2017.8759]
[8] Brent J. Current management of ethylene glycol poisoning. Drugs. 2001;61(7):979-88. [DOI: 10.2165/00003495-200161070-00003]
[9] Peragallo J, Biousse V, Newman NJ. Ocular manifestations of drug and alcohol abuse. Curr Opin Ophthalmol. 2013;24(6):566-73. [DOI: 10.1097/ICU.0b013e3283654e32]
[10] Besenhofer LM, McLaren MC, Latimer B, Bartels M, Filary MJ, Perala AW, McMartin KE. Role of tissue metabolite accumulation in the renal toxicity of diethylene glycol. Toxicol Sci. 2011;123(2):374-83. [DOI: 10.1093/toxsci/kfr173]
[11] de Almeida Araújo S, Faria BCD, Vasconcelos JC, da Cruz AF, de Souza VS, Wanderley DC, Simões ESAC. Renal toxicity caused by diethylene glycol: an overview. Int Urol Nephrol. 2023;55(11):2867-75. [DOI: 10.1007/s11255-023-03674-0]
[12] Alfred S, Coleman P, Harris D, Wigmore T, Stachowski E, Graudins A. Delayed neurologic sequelae resulting from epidemic diethylene glycol poisoning. Clin Toxicol (Phila). 2005;43(3):155-9. [DOI: 10.1081/CLT-200056981]
[13] Orhan U, Gulen M, Satar S, Acehan S, Nazik H, Unlu N, et al. Hemodialysis treatment for poisoning patients in the emergency department. Ther Apher Dial. 2023;27(3):580-6. [DOI: 10.1111/1744-9987.14000]
[14] Seltzer JA, Corbett B, Lasoff DR, Clark RF. Symptomatic Diethylene Glycol Ingestion Successfully Treated with Fomepizole Monotherapy. J Emerg Med. 2022;63(1):58-61. [DOI: 10.1016/j.jemermed.2022.01.021]
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