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Delayed myocardial injury following acute hydrogen sulfide intoxication.

INTRODUCTION
Hydrogen sulfide is a toxic, colorless gas produced by decaying organic matter. Its toxic effects are due to blocking of cellular respiratory enzymes, leading to anoxia.


CASE PRESENTATION
We report a 28-year-old man who attempted suicide using hydrogen sulfide gas. When the emergency service arrived, his friend was dead and the patient was unconscious. He received supportive treatment and survived. In this patient both skeletal muscle and myocardial injury was observed after hydrogen sulfide intoxication. Skeletal muscle damage occurred first, because enzymes peak consisted of creatine phosphokinase, aspartate aminotransferase, and myoglobin was observed on hospital day 4. Myocardial injury was apparent on hospital day 15, because the subsequent enzymes peak was comprised of cardiac enzymes and associated electrocardiographic abnormalities. On hospital day 3, myocardial injury was detected and it evolved over the next 3 weeks to recover completely.


CONCLUSION
The mechanisms of rhabdomyolysis and myocardial injury resulting from hydrogen sulfide poisoning are not known, but may be related to cellular anoxia or a direct toxic effect. This case highlights not only the risk of delayed cardiac damage, but also rhabdomyolysis, and emphasizes that careful monitoring of cardiac function and of the levels of skeletal muscle-related enzymes is essential for victims of hydrogen sulfide poisoning.