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Disulfiram is a deterrent agent, prescribed to motivated patients, with their informed consent for the relapse prevention of alcohol dependence (AD).1 Supervised disulfiram treatment has proven efficacy for AD.1 There are reports of unregistered medical practitioners in India prescribing disulfiram surreptitiously.2
Neurotoxic side effects of disulfiram may be abrupt, in the form of fatigue, amnesia, confusion and behavioural changes; subacute in the form of ataxia, stupor, psychosis, seizure and encephalopathy; and chronic in the form of optic neuritis, ptosis and peripheral neuropathy.3 Previous reports of neurological sequelae with disulfiram have highlighted that a high dose of disulfiram, either supervised3 or as a single high-dose suicidal attempt,4 lead to these complications.
We report a case of subacute onset of neurological sequelae with therapeutic doses of disulfiram administered surreptitiously, without medical consultation and recovery within 6 weeks of stopping disulfiram.
A 32-year-old male, with family history of AD in one first-degree relative, personal history of nicotine dependence for 7 years and AD for 9 years presented with complaints of pain in both legs for 10 days, hoarseness of voice and drooping of both eyelids for 8 days.
On repeated enquiry, the patient's wife admitted to …