2024 Volume 37 Issue 1 Pages 29-35
Distigmine bromide is widely used to treat neurogenic bladder. It may cause cholinergic crisis, a serious side effect. We report the case of an 86-year-old woman with neurogenic bladder who had been taking 5 mg of distigmine bromide orally daily for over a year. She presented to our emergency room unconscious with hypotension and bradycardia. She was intubated, high-dose catecholamine was administered, and a temporary pacemaker was placed. She remained hypotensive. Based on her physical findings, particularly excessive sweating, myosis, and increased salivation, along with low serum cholinesterase, cholinergic crisis due to distigmine bromide was diagnosed. We attempted to resuscitate her with intravenous atropine；however, she died from intestinal necrosis. This case suggests that even a low dose of distigmine bromide can induce a cholinergic crisis. Differential diagnosis is difficult in the early phase of the disease. When examining a patient who is taking distigmine bromide, always considering the possibility of the toxidrome of cholinesterase inhibiters is essential.
