Zeitschrift für klinische Toxikologie
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A Trial of Therapeutic Plasma Exchange in Intramuscular Ricin Poisoning

Bhavya Sharma, Jay Patel, Timothy Schaub, Joseph Myers, Rupesh Raina*

Ricin poisoning is an exceedingly rare clinical scenario encountered in the field of toxicology. Potential routes of exposure consist of injection, inhalation, or ingestion. The ricin toxin’s mechanism of action involves inhibition of protein synthesis, and the corresponding clinical findings can include nausea, vomiting, shortness of breath, pulmonary edema, cutaneous and visceral necrosis, multi-organ failure, and sepsis. Renal failure is often encountered, and the appropriate management is not currently established in the literature. We report a fatal case of intramuscular ricin injection leading to renal failure in a 37-year-old male. To our knowledge, there has been only one prior confirmed lethal case of intramuscular poisoning. Our case is also the first to evaluate the efficacy of Plasma Exchange (PLEX) in adult ricin poisoning. Although treatment remains supportive, we believe our case provides valuable insight and highlights the need for further investigation.