2) Diagnose the signs and symptoms of lindane toxicity in adults. CASE INFORMATION: The toxicity of lindane is well known for the pediatric population, but is generally under appreciated among adults. Inappropriate application of lindane by adults can lead to significant neurologic changes and even death. A 22-year-old thin female without significant medical history was brought to the emergency room by her mother after one day of agitation, visual and tactile hallucinations, paranoia and a five-day history of rash. The rash consisted of pruritic erythematous macules on her abdomen and body. The patient was seen at an outlying emergency room, diagnosed with scabies and given lindane cream. Her rash persisted and she went to another emergency room for evaluation; again she was diagnosed with the scabies and prescribed lindane. 2 days later she presented with the above symptoms. Her exam showed numerous crusted, mildly erythematous erosions and excoriations throughout her body. No vesicles or burrows were noted. She was agitated with paranoia and visual hallucinations. An extensive workup was essentially negative and included a normal lumbar puncture, negative blood cultures and herpes simplex PCR, an unremarkable head CT, no vasculitic change on skin biopsy, and negative serologic studies for RMSF, varicella zoster, syphilis, cryptococcus and HIV. After her sensorium cleared she acknowledged that she left the lindane cream on for 12 to 16 hours, applied it all over her body and did not wash her sheets. She was discharged in stable condition without any neurologic deficits. IMPLICATIONS/DISCUSSION: Although lindane deposits in all lipid tissues, it has a high propensity for the white matter of the brain. Generally, children are at higher risk for toxicity because of their smaller size and lipid deposits. However, thin adults like the one described above, are also susceptible. Lindane absorption is enhanced by its contact with irritated skin, another risk factor also present in our case. Lindane toxicity is a clinical diagnosis and as such must be kept in mind especially in patients presenting with a history of ascabies-like rash and mental status changes.