Manganese toxicity presenting as acute psychosis- A case report

Abstract

Manganese poisoning is a toxic condition due to excessive exposure to manganese which can present with neurological or psychiatric symptoms. Here is a case report of a 51 years old male with occupational history, brought to the Emergency Room with two days history of acute onset behavioural disturbances. There was a history of taking Siddha medications for the last 4 months for polyarthralgia with minimal improvement. A diagnosis of organic psychotic disorder due to Manganese intoxication was made. MRI Brain plain and contrast were normal. The heavy metal screen was suggestive of high Manganese of 42 mg/ml and Cobalt of 4.4 ng/ml EEG was suggestive of generalized epileptiform abnormality. The patient was asked to refrain from further exposure to heavy metals and treated with Sodium valproate and neuro vitamins with gradual improvement in symptoms. This case report emphasizes the need for detailed evaluation and ruling out other medical conditions in a case presenting with the first episode of psychosis.