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Favourable evolution of a deep humeral thrombophlebitis after paraffin oil injection

To the Editor:

To our knowledge, the effects of iv injection of paraffin oil had not been reported prior to our recent publication.¹ We wish to report on the long term follow-up of this unusual case.

A young man, age 18 yr, injected himself 2.5 mL of paraffin oil in the right humeral vein. Thrombophlebitis and thrombosis of the deep humeral vein ensued, treated initially with iv heparin, dexamethasone and antibiotics. Oral anticoagulant and anti-inflammatory treatment was pursued orally after discharge. The patient abandoned the treatment five months later. On follow-up 13 months after the event, clinical examination was essentially normal and a repeat phlebography showed a 50% reperfusion of the venous vasculature. (Figure).

View larger version (137K): [in this window] [in a new window]   FIGURE Phlebography 31 days and 13 months after the injection of paraffin oil in the right humeral vein: the deep humeral vein remained thrombosed. On follow-up at 13 months, the radial, inter-osseous and cubital veins were reperfused.

The subcutaneous injection of petroleum distillates produces vein thrombosis by contact.³ Direct iv injection resulted in more severe and extensive deep vein thrombosis. Despite therapy and partial recuperation of the venous circulation, thrombosis of the humeral vein was irreversible. Had the patient pursued treatment, venous reperfusion may have been more complete. However, functional recuperation was good.

We believe prompt and sustained treatment with anticoagulants and anti-inflammatory drugs contributed to the favourable outcome observed in this case.

References

1 Aguèmon AR, Diallo AT, Biaou O, Atchadé D. A propos d'un cas d'intoxication aiguë par injection intraveineuse directe de pétrole. Ann Fr Anesth Réanim 2000; 19: 758–60.[Medline]

2 Musshoff F, Schmidt P, Madea B, Pohl C. An unusual case of self-harm with petroleum distillate. Arch Kriminol 2000; 205: 37–43.[Medline]

3 Rush MD, Schoenfeld CN, Watson WA. Skin necrosis and veinous thrombosis from subcutaneous injection of charcoal lighter fluid (naphta). Am J Emerg Med 1998; 16: 508–11.[Medline]

4 Frejaville JP, Bismuth C, Conso F. Hydrocarbures aromatiques. Toxicologie clinique, 3è éd. Paris: Flammarion 1981: 450–62.

5 Tournier G. Accidents d'inhalation Dans: Huant G, et al., (Eds).. Pédiatrie D'urgence, 2e éd. Paris : Flammarion 1981; 20–4.

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