Advertisement

Poisoning from “Spanish fly” (cantharidin)

      This paper is only available as a PDF. To read, Please Download here.

      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.

      Keywords

      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Till JS
        • Majmudar BN
        Cantharidin poisoning.
        South Med J. 1981; 74: 444-447
        • Presto III, AJ
        • Muecke EC
        A dose of Spanish fly.
        JAMA. 1970; 214: 591-592
        • Carrel JE
        • McCairel MH
        • Slagle AJ
        • et al.
        Cantharidin production in the blister beetle.
        Experientia. 1993; 49: 171-174
        • Polettini A
        • Crippa O
        • Ravagli A
        • Saragoni A
        A fatal case of poisoning with cantharidin.
        Forensic Sci Int. 1992; 56: 37-43
        • Nickolls LC
        • Teare D
        Poisoning by cantharidin.
        BMJ. 1954; 2: 1384-1388
        • Munsen J
        An effective treatment for bilharzial fibrosis and calcification of the bladder.
        J Urol. 1966; 96: 459-460
        • Coskey RJ
        Treatment of plantar warts in children with a salicylic acid-podophyllin-canthridin product.
        Pediatric Dermatol. 1984; 2: 71-73
        • Browne SG
        Cantharidin poisoning due to a blister beetle.
        BMJ. 1960; 2: 1290-1291
        • Wertelecki W
        • Vietti TJ
        • Kulapongs G
        Cantharidin poisoning from ingestion of a blister beetle.
        Pediatrics. 1967; 39: 287-289
        • Honkanen RE
        Cantharidin: Another natural toxin that inhibits the activity of serine/threonine protein phosphatases types 1 and 2A.
        FEBS Lett. 1993; 330: 283-286
        • Li YM
        • Casida JE
        Canthridin-binding protein: identification as protein phospatase 2A.
        in: ed 25. Proc Natl Acad Sci USA. 89. 1992: 11867-11870
        • Oaks WW
        • DiTunno DJ
        • Magnani T
        • et al.
        Cantharidin poisoning.
        Arch Intern Med. 1960; 105: 574-582
        • Craven JD
        • Polak A
        Cantharidin poisoning.
        BMJ. 1954; 2: 1386-1389
        • Rabkin SW
        • Friesen JM
        • Ferris JA
        • et al.
        A model of cardiac arrhythmias and sudden death: Cantharidin induced toxic cardiomyopathy.
        J Pharmacol Exp Ther. 1979; 210: 43-50
        • Friesen JM
        • Ferris JA
        • Rabkin SW
        • et al.
        Pathological features of cantharidin induced toxic cardiomyopathy.
        Forensic Sci. 1979; 13: 187
        • Anderson K
        • Rouse T
        • Randolf J
        A controlled trial of corticosteroids in children with corrosive injury of the esophagus.
        N Engl J Med. 1990; 323: 637-640
        • Howell J
        • Dalsey W
        • Hartsell FW
        • et al.
        Steroids for the treatment of corrosive esophageal injury: A statistical analysis of past studies.
        Am J Emerg Med. 1992; 10: 421-425