Fatal Paraphenylenediamine (Hair Dye) Intoxication in a Child Resembling Ludwig's Angina

Abstract

A 6 year-old child with paraphenylenediamine intoxication is presented. The patient suffered from sore throat, cough, and anorexia, followed by severe dyspnea caused by edema of the tongue, pharynx, and neck, renal failure, and metabolic acidosis. A presumptive diagnosis of Ludwig's angina, a severe anaerobic infection of the sublingual neck space, was entertained. Despite institution of vigorous supportive therapy and administration of antibiotics, the child developed irreversible ventricular fibrillation and died eight hours after admission. Two days after the patient's death, his father recalled that the child and his dog ingested an unidentified substance shortly before the onset of the child's symptoms. The dog died within a few hours. The substance was identified as the hair dye, paraphenylenediamine.