Severe Hypoxic-ischaemic Encephalopathy and Takotsubo Cardiomyopathy Following Accidental Butane Exposure: A Case Report

BACKGROUND: Butane is a highly lipophilic aliphatic hydrocarbon widely used as a domestic fuel and aerosol propellant. Acute exposure in enclosed environments may cause severe neurological and cardiovascular toxicity through oxygen displacement, respiratory depression, myocardial sensitisation to catecholamines, and potentially direct toxic effects. CASE PRESENTATION: A 45-year-old woman was found unconscious in a small, closed studio apartment, while her husband was found deceased in the same environment. Subsequent inspection by the judicial authorities identified deterioration of the gas tubing associated with a gas leak. The patient presented in deep coma (Glasgow Coma Scale score 5) and required tracheal intubation and mechanical ventilation. Initial carboxyhaemoglobin was 16.9% and progressively normalised during oxygen therapy. Brain imaging demonstrated extensive cortical, deep grey matter, brainstem, cerebellar, and white-matter abnormalities consistent with severe hypoxic-ischaemic injury. Cardiac evaluation showed mild ST-segment elevation, increased cardiac biomarkers, and severe transient Left Ventricular Systolic Dysfunction (LVEF 25%) with a pattern highly suggestive of Takotsubo cardiomyopathy; LVEF subsequently improved to 44%. Severe neurological impairment persisted, and the patient was transferred to neurological rehabilitation. She died approximately six months after the index event; reliable documentation of the precise cause of death was unavailable. CONCLUSION: This case illustrates the severe neurological and cardiovascular consequences that may follow accidental butane exposure in an enclosed environment. The coexistence of extensive hypoxic- ischaemic brain injury and transient stress-related ventricular dysfunction highlights the importance of integrated neurological, cardiological, and toxicological assessment.