Anaphylactic Shock Following Spray of “Gulliver” (Azimsulfuron), A Herbicide Belong To Sulfonylurea Group; A Case Report

Background: Anaphylactic shock is a life threatening emergency encountered frequently with rising incidence worldwide. It is an extreme end of a spectrum of allergic reactions commonly present following multiple triggers, including food, medications, insect stings, dyes, etc. Patients usually present with a combination of dermatological, cardiovascular, respiratory and gastrointestinal symptoms. This is a rarely encountered case of anaphylactic shock following the spraying of sulphur containing herbicide called “Gulliver” (Azimsulfuron). Case presentation This 58-year-old farmer with previously uneventful past medical history was admitted to the emergency unit with an episode of faintishness and urticarial rash while working in a paddy field. There was no shortness of breath, wheezing or angioedema. He revealed that he had sprayed an herbicide call ‘Gulliver’ (Azimsulfuron, a sulphur containing herbicide) in the morning for 3 to 4 hours without using proper protective equipments and cloths. He denied any insect bites or stings. On admission, he was in shock with blood pressure 60/48mmHg, pulse rate 84 beats per minute with bounding pulses and warm peripheries. He was managed as anaphylactic shock according to the national health guideline and hemodynemically stabilized within 20 minutes of initial resuscitation including intramuscular adrenaline. Conclusions: It is a well-known fact that a significant proportion of the general population has an allergy to sulphur containing medications. However, this was a rare encounter, detected with a high degree of suspicion. In Sri Lanka, a survey in 2016/2017 revealed 27 percent of the total labour force was engaged in the agricultural sector. We emphasize the importance of consideration of allergy and anaphylaxis in similar presentation in an agricultural based country like Sri Lanka.