A 43-year-old male with no past medical history presented to our emergency department with vomiting, diarrhea, and abdominal pain of 3 h’ duration. Upon further questioning, he revealed that he had been applying malathion pesticide over his body for the past 3 days for self-diagnosed scabies. He was otherwise afebrile and hemodynamically stable, and the physical examination was unremarkable. The patient was diagnosed with organophosphate poisoning and treated symptomatically due to the lack of worrying cardiorespiratory or neurologic sequelae. He was subsequently admitted to the general ward, where his symptoms abated within 4 h. Serum and red blood cell cholinesterase tests sent on admission returned on day three and were significantly decreased (serum cholinesterase 2131 U/L, reference range 4700–12000 U/L; red blood cell cholinesterase 3365 U/L, reference range 7700–14600 U/L). He was discharged home well and stable on day 5 of admission, with outpatient psychiatric follow-up for likely delusional parasitosis.

1. Gunnell, D, Eddleston, M, Phillips, MR, et al. The global distribution of fatal pesticide self-poisoning: systematic review. BMC Public Health 2007; 7: 357. DOI: 10.1186/1471-2458-7-357.
Google Scholar | Crossref | Medline | ISI2. Eddleston, M . Insecticides: organic phosphorous compounds and carbamates. In: Nelson, LS, Howland, MA, Lewin, NA, et al. (eds) Goldfrank’s toxicologic emergencies. 11 ed. New York: McGraw-Hill Education, 2019, pp. 1486–1502.
Google Scholar3. King, AM, Aaron, CK. Organophosphate and carbamate poisoning. Emerg Med Clin North Am 2015; 33: 133–151. DOI: 10.1016/j.emc.2014.09.010.
Google Scholar | Crossref | Medline4. Greene, S . Pesticides. In: Tintinalli, JE, John Ma, O, Yealy, DM, et al. (eds) Tintinalli’s emergency medicine: a comprehensive study guide. 9 ed. New York: McGraw-Hill Education, 2020, pp. 1300–1309.
Google Scholar5. Namba, T, Nolte, CT, Jackrel, J, et al. Poisoning due to organophosphate insecticides. Acute and chronic manifestations. Am J Med 1971; 50: 475–492. DOI: 10.1016/0002-9343(71)90337-8.
Google Scholar | Crossref | Medline | ISI6. Buckley, NA, Eddleston, M, Li, Y, et al. Oximes for acute organophosphate pesticide poisoning. Cochrane Database Syst Rev 2011; (2): Cd005085. DOI: 10.1002/14651858.CD005085.pub2.
Google Scholar | Crossref | Medline7. Alikhan, FS, Maibach, H. Topical absorption and systemic toxicity. Cutan Ocul Toxicol 2011; 30: 175–186. DOI: 10.3109/15569527.2011.560914.
Google Scholar | Crossref | Medline | ISI8. Maibach, HI, Feldman, RJ, Milby, TH, et al. Regional variation in percutaneous penetration in man. Pesticides. Arch Environ Health 1971; 23: 208–211. DOI: 10.1080/00039896.1971.10665987.
Google Scholar | Crossref | Medline9. Wester, RC, Maibach, HI, Bucks, DA, et al. Malathion percutaneous absorption after repeated administration to man. Toxicol Appl Pharmacol 1983; 68: 116–119. DOI: 10.1016/0041-008x(83)90360-5.
Google Scholar | Crossref | Medline10. Capt, A, Luzy, AP, Esdaile, D, et al. Comparison of the human skin grafted onto nude mouse model with in vivo and in vitro models in the prediction of percutaneous penetration of three lipophilic pesticides. Regul Toxicol Pharmacol 2007; 47: 274–287. DOI: 10.1016/j.yrtph.2006.11.008.
Google Scholar | Crossref | Medline11. van Heel, W, Hachimi-Idrissi, S. Accidental organophosphate insecticide intoxication in children: a reminder. Int J Emerg Med 2011; 4: 32. DOI: 10.1186/1865-1380-4-32.
Google Scholar | Crossref | Medline12. Wenzl, JE, Burke, EC. Poisoning from a malathion-aerosol mixture. A case report. Jama 1962; 182: 495–497. DOI: 10.1001/jama.1962.03050430169028a.
Google Scholar | Crossref | Medline13. Rutter, N . Drug absorption through the skin: a mixed blessing. Arch Dis Child 1987; 62: 220–221. DOI: 10.1136/adc.62.3.220.
Google Scholar | Crossref | Medline14. Casida, JE, Sanderson, DM. Toxic hazard from formulating the insecticide dimethoate in methyl ‘Cellosolve’. Nature 1961; 189: 507–508. DOI: 10.1038/189507a0.
Google Scholar | Crossref | Medline15. Jensen, IM, Whatling, P. Malathion: a review of toxicology. In: Krieger, RI (ed) Hayes’ handbook of pesticide toxicology. 3 ed. London: Academic Press, 2010, pp.1527–1542.
Google Scholar | Crossref