{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:20:34Z","timestamp":1791246034083,"version":"4.1.0"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T00:00:00Z","timestamp":1750723200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Diquat (1,1\u2032-ethylene-2,2\u2032-bipyridine), a non-selective herbicide with significant human toxicity, is increasingly used as a substitute for paraquat in weed management practices in China. Diquat intoxication is typified by multiple organ dysfunction syndrome (MODS), predominantly manifesting as acute renal and hepatic injury, and frequently resulting in central nervous system (CNS) impairment with a poor prognosis in severe instances. Despite the rising incidence of diquat poisoning, the imaging characteristics of diquat-induced toxic encephalopathy remain inadequately documented in the literature. In this report, we present a distinctive case involving a female pediatric patient who exhibited MODS affecting the neurologic, renal, hepatic, cardiac, and gastrointestinal systems, in conjunction with rhabdomyolysis. Magnetic resonance imaging (MRI) revealed multiple abnormal signals in the pons, bilateral brachium pontis, thalamus, caudate nucleus, putamen, posterior part of the external capsule, and posterior limb of the right internal capsule. These findings are consistent with the imaging characteristics of osmotic demyelination syndrome (ODS), which is under-recognized but important. After comprehensive systemic treatment, the patient was discharged on the 30th day post-admission.<\/jats:p>","DOI":"10.3389\/fmed.2025.1465003","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T15:30:36Z","timestamp":1750779036000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Diquat poisoning, maybe another cause of osmotic demyelination syndrome: case report and literature review"],"prefix":"10.3389","volume":"12","author":[{"given":"Wenfu","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"600","DOI":"10.3238\/arztebl.2019.0600","article-title":"Central pontine myelinosis and osmotic demyelination syndrome","volume":"116","author":"Lambeck","year":"2019","journal-title":"Dtsch Arztebl Int"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1443","DOI":"10.1111\/ene.12571","article-title":"Central pontine and extrapontine myelinolysis: a systematic review","volume":"21","author":"Singh","year":"2014","journal-title":"Eur J Neurol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1080\/15563650.2021.2013495","article-title":"Acute diquat poisoning resulting in toxic encephalopathy: a report of three cases","volume":"60","author":"Yu","year":"2022","journal-title":"Clin Toxicol (Phila)"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"300060520943824","DOI":"10.1177\/0300060520943824","article-title":"Lethal diquat poisoning manifesting as central pontine myelinolysis and acute kidney injury: a case report and literature review","volume":"48","author":"Xing","year":"2020","journal-title":"J Int Med Res"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1016\/j.jns.2017.01.024","article-title":"Temporal evolution of the trident and piglet signs of osmotic demyelination syndrome","volume":"373","author":"Beh","year":"2017","journal-title":"J Neurol Sci"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1148\/rg.293085151","article-title":"Best cases from the AFIP: osmotic demyelination syndrome","volume":"29","author":"Howard","year":"2009","journal-title":"Radiographics"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1212\/wnl.42.1.261","article-title":"Acute and persistent parkinsonism after use of diquat","volume":"42","author":"Sechi","year":"1992","journal-title":"Neurology"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1081\/clt-100102470","article-title":"Vaginally applied diquat intoxication","volume":"37","author":"Rudez","year":"1999","journal-title":"J Toxicol Clin Toxicol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"9272","DOI":"10.1007\/s12035-024-04172-x","article-title":"Imaging findings and toxicological mechanisms of nervous system injury caused by diquat","volume":"61","author":"Ren","year":"2024","journal-title":"Mol Neurobiol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2283590","DOI":"10.1080\/0886022x.2023.2283590","article-title":"Clinical and pathological characteristics of diquat poisoning-related acute kidney injury","volume":"45","author":"Xia","year":"2023","journal-title":"Ren Fail"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1089\/ars.2005.7.649","article-title":"Toxicity of redox cycling pesticides in primary mesencephalic cultures","volume":"7","author":"Bonneh-Barkay","year":"2005","journal-title":"Antioxid Redox Signal"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1007\/s11064-010-0163-x","article-title":"Increased reactive oxygen species production in the brain after repeated low-dose pesticide paraquat exposure in rats. A comparison with peripheral tissues","volume":"35","author":"Kuter","year":"2010","journal-title":"Neurochem Res"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1016\/s0196-0644(83)80474-0","article-title":"Diquat intoxication","volume":"12","author":"McCarthy","year":"1983","journal-title":"Ann Emerg Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"184","DOI":"10.3390\/toxics11020184","article-title":"Multi-omics analyses reveal the mechanisms of early stage kidney toxicity by diquat","volume":"11","author":"Zhang","year":"2023","journal-title":"Toxics"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"991587","DOI":"10.3389\/fpubh.2022.991587","article-title":"Case series: diquat poisoning with acute kidney failure, myocardial damage, and rhabdomyolysis","volume":"10","author":"Yu","year":"2022","journal-title":"Front Public Health"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1178272","DOI":"10.3389\/fneur.2023.1178272","article-title":"Case report: reversible splenial lesion syndrome caused by diquat poisoning","volume":"14","author":"Dai","year":"2023","journal-title":"Front Neurol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1007\/s00134-021-06354-w","article-title":"The piglet and the trident sign in osmotic demyelination syndrome","volume":"47","author":"Balcerac","year":"2021","journal-title":"Intensive Care Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1136\/pmj.77.907.329","article-title":"Acute diquat poisoning with intracerebral bleeding","volume":"77","author":"Saeed","year":"2001","journal-title":"Postgrad Med J"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.1016\/0002-9343(81)90836-6","article-title":"Diquat intoxication: report of two cases and review of the literature","volume":"70","author":"Vanholder","year":"1981","journal-title":"Am J Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1177\/0960327118765330","article-title":"Human and experimental toxicology of diquat poisoning: toxicokinetics, mechanisms of toxicity, clinical features, and treatment","volume":"37","author":"Magalh\u00e3es","year":"2018","journal-title":"Hum Exp Toxicol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1081\/clt-100100926","article-title":"Mechanisms of toxicity, clinical features, and management of diquat poisoning: a review","volume":"38","author":"Jones","year":"2000","journal-title":"J Toxicol Clin Toxicol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1465003\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T15:30:36Z","timestamp":1750779036000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1465003\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,24]]},"references-count":21,"alternative-id":["10.3389\/fmed.2025.1465003"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1465003","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,24]]},"article-number":"1465003"}}