Floral phantosmia and bradycardia: A unique case of digoxin toxicity in an elderly patient

Abstract

This case report presents a rare clinical manifestation of digoxin toxicity in a 73-year-old female with acute kidney injury, bradycardia, and unique sensory disturbances, including phantosmia (floral scent hallucinations) and photopsia (seeing sparkles of light). The patient, with a history of hypertension and atrial fibrillation, had been on digoxin for 2 weeks, raising concerns about possible digoxin intoxication. Upon admission, bradycardia, hypokalemia, and elevated serum digoxin levels confirmed toxicity. The patient's olfactory and visual hallucinations, rare symptoms in such cases, gradually resolved after stopping digoxin. This case emphasizes the importance of recognizing subtle and unusual symptoms, like changes in smell and vision, which can enhance early detection, especially in older patients, leading to quicker interventions and better patient outcomes.

Keywords: Digoxin intoxication; drug interactions; older patients; phantosmia; renal failure.

Figure 1

Electrocardiogram of the patient on the 1^st (a) and the 7^th day (b)