Incense Exposure–Related Salicylate Toxicity may Cause Seizures in a Child: Case report
USA: A young girl developed a rare case of pediatric seizures after repeated exposure to incense sticks burned at home. She was diagnosed with chronic salicylate intoxication, a condition in children that may present subtly but can have life-threatening consequences, including seizures, cerebral edema, severe acid–base imbalance, and multi-organ dysfunction.
A case report published in the American Journal of Case Reports by Priyanka Shekhawat and colleagues from the Department of Neurology, Mass General Brigham, highlights an unusual but important source of toxic exposure in children. While cases of acute salicylate poisoning have declined due to regulatory measures such as reduced aspirin content and child-resistant packaging, salicylates remain present in several commonly used household products, including incense sticks and scented candles.
The report describes a 3-year-old girl who was brought to the emergency department after experiencing her first episode of a non-febrile generalized tonic-clonic seizure. Initial physical examination did not reveal any abnormalities. However, arterial blood gas analysis showed a mixed acid–base disorder, characterized by respiratory alkalosis along with metabolic acidosis, raising suspicion of a toxic or metabolic cause.
Laboratory evaluation revealed an elevated serum salicylate level of 19 mg/dL, which slightly decreased to 17 mg/dL after five hours. During her stay in the pediatric intensive care unit, the child experienced two additional seizure episodes, prompting initiation of anticonvulsant therapy with fosphenytoin. Notably, there was no history of trauma, prior illness, or known toxin exposure, and her developmental milestones were appropriate for age. Further investigations, including an electroencephalogram and a brain MRI, were normal, making the diagnosis more challenging.
A detailed environmental assessment proved crucial in identifying the underlying cause. Investigation by child welfare authorities revealed that the child had been regularly exposed to incense stick fumes at home, which contained significant amounts of salicylates. No other sources of exposure were identified, pointing to chronic inhalational exposure as the likely cause of toxicity.
Following the discontinuation of incense use and appropriate counseling of the parents, the child showed complete recovery. She remained seizure-free on follow-up and continued to achieve normal developmental milestones, highlighting the reversibility of the condition with timely recognition and intervention.
The authors emphasize that chronic salicylate toxicity can present insidiously in children and may be easily overlooked, particularly when exposure is indirect or environmental. The case underscores the importance of considering household sources when evaluating unexplained metabolic disturbances or new-onset seizures in pediatric patients.
They also call for clearer labeling of salicylate-containing products to increase awareness of potential risks. Clinicians are urged to maintain a high index of suspicion and to conduct thorough environmental histories in such cases. Early identification and removal of the exposure source can be lifesaving and prevent long-term complications.
Reference:
DOI: 10.12659/AJCR.952094
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