Peri-anal injury following ingestion of White Spirit

To the Editor:

White Spirit, a hydrocarbon solvent-based paint remover, has a de-fatting action. Dermal exposure can cause irritation, blistering, necrosis and burns.¹ We present a case series of peri-anal injury following White Spirit ingestion.

(1) A male adult attended an Emergency Department (ED), following ingestion of 350 mL of White Spirit and 500 mL of plant fertiliser. At 1 hour post ingestion, he had vomiting, abdominal pain and diarrhoea. Initial blood results showed hyperkalaemia (K⁺ = 5.3 mmol/L), which resolved with Insulin/Dextrose (K⁺ = 4.8 mmol/L). He had no further diarrhoea although “a hydrocarbon odour” was reported. At 48 hours post ingestion, he had blistering, redness, broken skin and excoriation around his anus. He received prophylactic intravenous Pantoprazole, intravenous Penicillin and oral Paracetamol for 3 days followed by oral antibiotics. The fertiliser probably caused hyperkalaemia but is unlikely to have contributed to the peri-anal injuries.

(2) A male adult attended an ED and required intubation via tracheostomy following trauma. At 24 hours post ingestion, he was alert and admitted ingesting 2L of White Spirits. At 48 hours post ingestion, a computed tomography contrast scan and an oesophago-gastroduodenoscopy showed corrosion on the tongue and hypopharynx, mild oesophagitis and gastritis. He had peri-anal burns and reported having several episodes of diarrhoea at home. Prophylactic Amoxycillin, Clarithromycin and Pantoprazole were prescribed.

(3) A female adult attended an ED 7 hours post ingestion of 1L of White Spirit. She had diarrhoea at home. She was commenced on intravenous Omeprazole for dyspepsia. At 16 hours post ingestion, she was passing watery rectal fluid, and had inflammation and severe excoriation to the inner thighs and peri-anal region. Analgesia (paracetamol 500 mg/codeine sulphate 30 mg), prophylactic oral antibiotics (Penicillin, Metronidazole) and topical silver sulphadiazine (1% w/w) were administered.

Peri-anal injury following White Spirit ingestion is rare with only two previous cases in the medical literature. Chemical burns occurred following ingestion of 750 mL of White Spirit in a patient who presented with diarrhoea and respiratory distress. At 48 hours post ingestion she had an erythematous rash to her buttocks and thighs which progressed to epidermal sloughing and necrosis. Diarrhoea persisted for 2-weeks.² Another patient (reported in a French Journal) ingested 500 mL of White Spirit, had diarrhoea at 3 hours post ingestion and developed isolated peri-anal burns. The authors proposed that White Spirit rapidly transited the gastrointestinal tract due to its high polysaccharide and low lipid content resulting in early-onset diarrhoea.³

The stratum corneum (outermost skin layer) is a lipid-rich intercellular protective barrier. White Spirit leaches lipids from the stratum corneum and repeated applications cause epidermal necrosis.⁴ The peri-anal stratum corneum is especially thin and prone to dematoses due to high concentrations of bacteria, humid conditions and the intertriginous nature of the region including the buttocks and thighs. Our patients had comparable symptomology and early-onset diarrhoea is thought to be associated with the development of peri-anal injuries due to the timely sequence of events. The use of prophylactic antibiotics remains controversial for the treatment of burns and topical silver sulphadiazine has been associated with an increased rate of burn wound infection.⁵

This case series reminds clinicians of the potential for peri-anal injuries following White Spirit ingestion. Physical assessment of the peri-anal region is prudent in symptomatic patients.

Declaration of interest

The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.