Paraphenylenediamine (PPD) Poisoning Mistaken for an Anaphylactic Reaction

Paraphenylenediamine (PPD) is commonly used in parts of Africa and Asia in combination with Lawsonia alba leaves (also widely known as henna) or as a substitute to dye the hair, palms, soles, or arms for wedding ceremonies or spiritual events. At the same time, it is quickly trending as an agent for suicidal attempts through ingestion. Toxicity is dose-dependent and can lead to serious complications both locally, such as angioedema and airway swelling, or systemically such as acute kidney injury, fatal arrhythmias, and acute hepatitis. We present a case of a 26-year-old pregnant female patient, with no known underlying medical history or known allergies. She ingested PPD-based dye in an attempt to end her life. She initially presented asymptomatically but started developing delayed toxicity symptoms including angioedema and acute liver failure. Her initial diagnosis was an anaphylaxis reaction, and her workup and management were conducted accordingly. We discuss the appropriate course of action in terms of investigations and management in cases of PPD poisoning, and what measures should have been taken in this patient to provide the best healthcare outcome.