Citation Information :
Vishnu NS, Tomar S, Jaggi S, Kumar SR, Sodhi MK. A Rare Case of Inhalational Paraquat Lung Injury Leading to Progressive Pulmonary Fibrosis. Indian J Respir Care 2023; 12 (3):266-271.
Introduction: Poisoning with various synthetic chemicals used in farming is a public health problem of considerable importance worldwide, particularly in developing countries. One of them is paraquat (PQ), which is an extensively used synthetic, nonselective, contact herbicide in the Indian agriculture industry. Although fatalities due to accidental or suicidal oral ingestion of PQ are common, inhalational injury due to this poison is very rare and often difficult to diagnose without a proper specific history, since the presenting symptoms are usually nonspecific.
Case presentation and progress: Here, we report a case of a 35-year-old male, who had an accidental inhalation of Paraquat that led to lung injury and further complications. Initially, the patient had mild flu-like respiratory symptoms, but later symptoms worsened and he progressed into pulmonary fibrosis within a span of 2–3 weeks.
Treatment and outcome: The patient was admitted and managed in respiratory intensive care unit (ICU). He was managed with steroids, prophylactic antibiotic therapy, and other supportive measures. During the treatment course, he developed bilateral secondary spontaneous pneumothorax. Initially, he responded to the steroid pulse therapy, but later the pulmonary fibrosis progressed further and the patient succumbed after 1 month of ICU admission.
Discussion andconclusion: Paraquat is a bipyridylium quaternary ammonium compound that will cause direct harm to the cellular structures by the production of various reactive oxygen species (ROS) and other free radicals. The lungs and kidneys are the most affected organs. The treatment of PQ intoxication is not well set out. Prompt supportive medical treatment is essential to minimize the damage and improve the chances of recovery.
Eddleston M, Wilks MF, Buckley NA. Prospects for treatment of paraquat-induced lung fibrosis with immunosuppressive drugs and the need for better prediction of outcome: a systematic review. QJM 2003;96(11):809–824. DOI: 10.1093/qjmed/hcg137
Samsamshariat S, Vedaei A, Jahangiri S, et al. Report of a case of paraquat poisoning and mediastinal involvement. Adv Biomed Res 2021;10:5. DOI: 10.4103/abr.abr_95_20
Kumar S, Gupta S, Bansal YS, et al. Pulmonary histopathology in fatal paraquat poisoning. Autops Case Rep 2021;11:e2021342. DOI: 10.4322/acr.2021.342
Kumar H, Singh VB, Meena BL, et al. Paraquat poisoning: a case report. J Clin Diagn Res 2016;10(2):OD10–OD11. DOI: 10.7860/JCDR/2016/15858.7204
Asaduzzaman M, Chando MR, Ahmed N, et al. Paraquat-induced acute kidney and liver injury: case report of a survivor from Bangladesh. Clin Case Rep 2021;9(11):e05020. DOI: 10.1002/ccr3.5020
Deng P, Chen Y, Li H, et al. Pneumomediastinum caused by occult paraquat poisoning: case report. Medicine (Baltimore) 2018;97(51):e13745. DOI: 10.1097/MD.0000000000013745
Dinis-Oliveira RJ, Duarte JA, Sánchez-Navarro A, et al. Paraquat poisonings: mechanisms of lung toxicity, clinical features, and treatment. Crit Rev Toxicol 2008;38(1):13–71. DOI: 10.1080/10408440701669959
Lin XH, Pan HY, Cheng FJ, et al. Association between liberal oxygen therapy and mortality in patients with paraquat poisoning: c multi-center retrospective cohort study. PLoS One 2021;16(1):e0245363. DOI: 10.1371/journal.pone.0245363
Im JG, Lee KS, Han MC, et al. Paraquat poisoning: findings on chest radiography and CT in 42 patients. AJR Am J Roentgenol 1991;157(4):697–701. DOI: 10.2214/ajr.157.4.1892020
Kang X, Hu DY, Li CB, et al. The volume ratio of ground glass opacity in early lung CT predicts mortality in acute paraquat poisoning. PLoS One 2015;10(4):e0121691. DOI: 10.1371/journal.pone.0121691
Zhou CY, Kang X, Li CB, et al. Pneumomediastinum predicts early mortality in acute paraquat poisoning. Clin Toxicol (Phila) 2015;53(6):551–556. DOI: 10.3109/15563650.2015.1046183
Gupta N, Chugh A, Kanwar BS, et al. A case report of paraquat poisoning. JIACM 2018;19(3):210–211.
Ntshalintshali SD, Manzini TC. Paraquat poisoning: ccute lung injury - a missed diagnosis. S Afr Med J 2017;107(5):399–401. DOI: 10.7196/SAMJ.2017.v107i5.12306
Yu G, Kan B, Jian X, et al. A case report of acute severe paraquat poisoning and long-term follow-up. Exp Ther Med 2014;8(1):233–236. DOI: 10.3892/etm.2014.1727