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Abstract
Cantharidin, known popularly as Spanish fly, has been used for millennia as a sexual
stimulant. The chemical is derived from blister beetles and is notable for its vesicant
properties. While most commonly available preparations of Spanish fly contain cantharidin
in negligible amounts, if at all, the chemical is available illicitly in concentrations
capable of causing severe toxicity. Symptoms of cantharidin poisoning include burning
of the mouth, dysphagia, nausea, hematemesis, gross hematuria, and dysuria. Mucosal
erosion and hemorrhage is seen in the upper gastrointestinal (GI) tract. Renal dysfunction
is common and related to acute tubular necrosis and glomerular destruction. Priapism,
seizures, and cardiac abnormalities are less commonly seen. We report four cases of
cantharidin poisoning presenting to our emergency department with complaints of dysuria
and dark urine. Three patients had abdominal pain, one had flank pain, and the one
woman had vaginal bleeding. Three had hematuria and two had occult rectal bleeding.
Low-grade disseminated intravascular coagulation, not previously associated with cantharidin
poisoning, was noted in two patients. Management of cantharidin poisoning is supportive.
Given the widespread availability of Spanish fly, its reputation as an aphrodisiac,
and the fact that ingestion is frequently unwitting, cantharidin poisoning may be
a more common cause of morbidity than is generally recognized. Cantharidin poisoning
should be suspected in any patient presenting with unexplained hematuria or with GI
hemorrhage associated with diffuse injury of the upper GI tract.
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Article Info
Publication History
Accepted:
December 2,
1995
Received:
November 22,
1995
Identification
Copyright
© 1996 Published by Elsevier Inc.
