Visual Loss and Rhabdomyolysis: A Case of Acute Methanol Intoxication

Methanol toxicity is a rare but potentially fatal condition, often associated with accidental or intentional ingestion of adulterated alcohol. Complications include high anion gap metabolic acidosis, visual disturbances, central nervous system involvement, and multi-organ dysfunction. Rhabdomyolysis, though less commonly reported, can be a serious sequel leading to Acute Renal Failure (ARF) and significant morbidity. We report the case of a 40-year-old male with chronic alcohol use who presented to the Emergency Department (ED) with bilateral lower limb weakness, pain, dark urine, abdominal discomfort, and visual blurring. He was in shock, with severe lactic acidosis (pH 15 mmol/L, a non-recordable bicarbonate (HCO3 ) level, and high anion gap of 40) and required immediate Intensive Care Unit (ICU) stabilisation. Laboratory investigations were deranged, including Creatine Kinase (CK) 39,000 IU/L, Lactate Dehydrogenase (LDH) 1738 IU/L, acute kidney injury, dyselectrolytaemia including refractory hyperkalaemia, hypocalcaemia, hyperphosphataemia, deranged liver enzymes, and an osmolar gap of 72, suggestive of toxic alcohol ingestioninduced rhabdomyolysis and visual loss. Further history revealed binge consumption of locally brewed alcohol (“tadi”), raising strong suspicion of methanol poisoning. Oral ethanol therapy was initiated, followed by multiple sessions of haemodialysis due to persistent acidosis, renal failure, and electrolyte imbalance. The patient showed gradual clinical improvement and was discharged with near-complete recovery. Methanol toxicity-induced rhabdomyolysis is a medical emergency that demands prompt recognition and intervention. This case underscores the importance of clinical vigilance and early empiric treatment in patients with suggestive history and biochemical findings, even before confirmatory tests are available. Timely haemodialysis and supportive care can significantly improve patient outcomes.