{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T10:47:39Z","timestamp":1792320459642,"version":"4.4.0"},"reference-count":11,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,1,8]]},"abstract":"<jats:p>Internet-facilitated self-diagnosis and treatment is becoming more prevalent, putting individuals at risk of toxicity when drugs are acquired without medical oversight. We report a patient with delusional parasitosis who consumed veterinary albendazole purchased on the Internet, leading to pancytopenia, transaminase elevation, and alopecia. A 53-year-old man was sent to the emergency department (ED) by his gastroenterologist because of abnormal laboratory results. The patient had chronic abdominal pain and believed he was infected with parasites. He purchased two bottles of veterinary-grade albendazole on the Internet, and over the 3 weeks before his ED visit, he consumed 113.6 g of albendazole (a normal maximal daily dose is 800 mg). Five days before admission, he noticed hair loss and a rash on his face. His examination was notable for significant scalp hair loss and hyperpigmentation along the jaw line. Laboratory studies were remarkable for pancytopenia (most notably a white blood cell count (WBC) of 0.4 \u00d7 10<jats:sup>3<\/jats:sup> cells\/mm<jats:sup>3<\/jats:sup>, with an absolute neutrophil count (ANC) of 0 \u00d7 10<jats:sup>3<\/jats:sup> cells\/mm<jats:sup>3<\/jats:sup>) and transaminase elevation (aspartate aminotransferase [AST] 268 IU\/L, alanine aminotransferase [ALT] 89 IU\/L). He developed a fever and was treated with antibiotics and colony-stimulating factors for presumed neutropenic bacteremia. Over the course of 1 week, his hepatic function normalized and his ANC increased to 3,000 \u00d7 10<jats:sup>3<\/jats:sup> cells\/mm<jats:sup>3<\/jats:sup>. Serial albendazole and albendazole sulfoxide concentrations were measured in serum and urine by liquid chromatography\u2013quadruple time-of-flight mass spectrometry. On day 2, his serum concentrations were 20.7 ng\/mL and 4,257.7 ng\/mL for albendazole and albendazole sulfoxide, respectively. A typical peak therapeutic concentration for albendazole sulfoxide occuring at 2\u20135 hours post-ingestion is 220\u20131,580 ng\/mL. Known adverse effects of albendazole include alopecia, transaminase elevation, and neutropenia. Pancytopenia leading to death from septic shock is reported. In our patient, prolonged use of high-dose albendazole resulted in a significant body burden of albendazole and albendazole sulfoxide, leading to pancytopenia, transaminase elevation, and alopecia. He recovered with supportive therapy.<\/jats:p>","DOI":"10.4269\/ajtmh.19-0198","type":"journal-article","created":{"date-parts":[[2019,11,4]],"date-time":"2019-11-04T07:01:08Z","timestamp":1572850868000},"page":"177-179","source":"Crossref","is-referenced-by-count":13,"title":["Case Report: Analytically Confirmed Severe Albenzadole Overdose Presenting with Alopecia and Pancytopenia"],"prefix":"10.4269","volume":"102","author":[{"given":"Morgan A. A.","family":"Riggan","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, Department of Medicine, Western University, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Perreault","sequence":"additional","affiliation":[{"name":"New York University School of Medicine, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Wen","sequence":"additional","affiliation":[{"name":"Clinical Toxicology and Environmental Biomonitoring Laboratory, University of California San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Raco","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, New York University Langone Health, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susi","family":"Vassallo","sequence":"additional","affiliation":[{"name":"Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy","family":"Gerona","sequence":"additional","affiliation":[{"name":"Clinical Toxicology and Environmental Biomonitoring Laboratory, University of California San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert S.","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Yearb Med Inform","first-page":"70","article-title":"Giving patients choice and control: health informatics on the patient journey","volume":"7","author":"Gann","year":"2012"},{"key":"b2","series-title":"BMJ","first-page":"h3480","article-title":"Evaluation of symptom checkers for self diagnosis and triage: audit study","volume":"351","author":"Semigran","year":"2015"},{"key":"b3","series-title":"Parasitol Today","first-page":"115","article-title":"The metabolism of benzimidazole anthelmintics","volume":"6","author":"Gottschall","year":"1990"},{"key":"b4","series-title":"Acta Tropica","first-page":"141","article-title":"Albendazole, mebendazole and praziquantel. 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Effect on serum tumor markers\/high incidence of neutropenia","volume":"61","author":"Morris","year":"2001"},{"key":"b10","series-title":"Am J Hematol","first-page":"53","article-title":"Aplastic anemia during treatment with albendazole","volume":"53","author":"Fernandez","year":"1996"},{"key":"b11","series-title":"Am J Trop Med Hyg","first-page":"291","article-title":"Death related to albendazole-induced pancytopenia: case report and review","volume":"72","author":"Opatrny","year":"2005"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/102\/1\/article-p177.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/102\/1\/article-p177.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/102\/1\/article-p177.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T15:39:01Z","timestamp":1722440341000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/102\/1\/article-p177.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,8]]},"references-count":11,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.19-0198","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1,8]]}}}