Amitraz poisoning mimicking organophosphate toxicity in a young woman: a clinically diagnosed case report from Western India

Amitraz is a formamidine insecticide and acaricide widely used in veterinary and agricultural settings. Human poisoning with amitraz is uncommon but potentially serious, primarily due to its alpha-2 adrenergic agonist activity, monoamine oxidase inhibition, and prostaglandin synthesis inhibition. It is frequently misdiagnosed as organophosphate poisoning, leading to inappropriate management. We present the case of a 26-year-old female from Himmatnagar, Gujarat, India, who ingested an amitraz formulation (12.5% w/v in xylene) with suicidal intent following a family conflict. The diagnosis was clinically established based on the characteristic toxidrome and identification of the commercial amitraz bottle by relatives. She presented to the emergency room within 30 min of ingestion with progressive drowsiness (Glasgow Coma Scale 11, declining to 6). Her clinical course was marked by central nervous system depression, miosis, transient bradycardia (treated with atropine), mild metabolic acidosis, and transient hyperglycemia (peak random blood glucose 225 mg/dL at 3 h, normalizing spontaneously). No significant respiratory depression or persistent hypotension was observed. She was managed with gastric lavage, activated charcoal, and supportive care in the intensive care unit. The patient regained full consciousness within 8 h and was discharged on the fourth day without sequelae following psychiatric evaluation. Amitraz poisoning, though underrecognized, can present with a clinical picture closely mimicking organophosphate toxicity. This case underscores the importance of early identification of amitraz as the causative agent, distinguishing it from organophosphate poisoning, and initiating prompt supportive management. The prognosis is generally favorable. Emergency physicians, particularly in rural and semi-urban India where veterinary insecticides are readily accessible over the counter, should maintain a high index of suspicion for amitraz toxicity in cases of unexplained CNS depression with miosis and bradycardia.