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A case of erectile dysfunction associated with chronic methyl bromide intoxication

International Journal of Impotence Research volume 17, pages 207–208 (2005)Cite this article

Methyl bromide (MeBr) is a commonly used fumigant to disinfect soil, grain and warehouses. It is a colorless and odorless volatile liquid with a boiling point of 3.6°C, which evaporates in an ambient atmospheric temperature.1 The first case of methyl bromide chronic poisoning was reported in 1963.2 Since this publication, some other observations have been reported describing cental neurological signs and peripheral neuropathies.3 The toxicity of methyl bromide has been thoroughly documented, but little information is available about the urological problems induced by methyl bromide intoxication. In this report, we present the first case of erectile dysfunction associated with chronic methyl bromide intoxication.

A 45-y-old man showed a gradual onset of erectile dysfunction 3 y ago. He was referred to us from a neurology clinic for evaluation and management of erectile dysfunction. He had worked in the fumigation department at a public food quarantine station for the last 12 y. In his first hospital visit, he complained of visual disturbance, dysarthria, decreased muscle strength and gait disturbance. There were no specific clues in his medical, familial or social histories, except his occupation. Under the suspicion of chronic occupational exposure to methyl bromide, the evaluation of the patient had been initiated by an inquiry based on the International Index of Erectile Function-5. He had a severe grade of dysfunction with a score of 5 in IIEF-5. Urinalysis and the serum hormonal assay were all within the normal range. Levels of methyl bromide in urine, serum and cerebrospinal fluid were 37.1, 11.2 and 28.8 mg/l, respectively, which were higher than the normal range. Intracavernosal injection tests showed decreased amplitude and duration of tumescence and rigidity. Biothesiometry showed decreased vibration senses in both the glans penis and the base. EMG studies showed a prolonged bulbocavernous reflex latency with the right side at 48.15 ms and the left side at 50.05 ms, and partial dysfunction was present on bilateral pudendal nerves or the sacral roots. A nerve conduction test showed a diffusive sensory–motor polyneuropathy, which includes decreased vibration sense below both iliac crests, disturbed position sense on both lower extremities and a tingling sensation below the lower half of the calf. These findings were enough to diagnose him with erectile dysfunction due to peripheral polyneuropathy caused by chronic exposure to methyl bromide. After exposure to methyl bromide had ceased, the patient was given carbamazepine 300 mg and amitryptiline 15 mg daily, as a supportive therapy. After 2 months, he recovered surreptitiously from visual disturbance, dysarthria, decreased muscle strength and gait disturbance, but late sequela, which were mainly neurological symptoms such as severe weakness with or without signs of paralysis, gait disturbance, blurred vision and neuropsychiatric disorders, still remained. For the remaining erectile dysfunction, an initial attempt was made by giving 3 mg apomorphine hydrochloride (Uprima®) sublingually, but it failed to show any signs of improvement in a total of eight trials. Following that, 50 mg sildenafil citrate (Viagra®) was given, and the IIEF-5 score increased from 5 to 10 in 6 months showing a continuous improvement.

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  1. Urology, Pusan National University Hospital, Busan, Republic of Korea

    H J Park, K M Lee, J K Nam & N C Park

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  1. H J Park
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  2. K M Lee
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  3. J K Nam
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  4. N C Park
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Correspondence to N C Park.

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Park, H., Lee, K., Nam, J. et al. A case of erectile dysfunction associated with chronic methyl bromide intoxication. Int J Impot Res 17, 207–208 (2005). https://doi.org/10.1038/sj.ijir.3901279

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