Background
Acute paraquat ingestion remains a leading cause of mortality in developing countries. There is currently no evidence that treatment with high-dose immunosuppressants and antioxidants improves survival in patients with paraquat poisoning, and better options are urgently needed. Here, we describe the unexpected survival and recovery of a patient with a potentially fatal paraquat poisoning.
Case presentation
After ingesting 28 mL of paraquat (20% ion w/v), confirmed by a deep blue color in the urine dithionite test (UDT), a 17-year-old Hispanic Colombian boy was treated according to the hospital protocol with cyclophosphamide, methylprednisolone, N-acetylcysteine, vitamin E and propranolol. Gastrointestinal endoscopy showed extensive ulceration and necrosis. As a novelty, enoxaparin at a single dose of 60 mg was added to his treatment. Despite the evidence of severe mucosal burns in the gastrointestinal tract and high paraquat concentrations found in the UDT, the clinical condition began to improve after 1 day of treatment, with full recovery and discharge from hospital after 21 days.
Conclusions
Although the amount of paraquat ingested by the patient was large and the UDT indicated severe poisoning with a somber prognosis, unexpected survival of the patient was observed, and the addition of enoxaparin was the only change from the standard treatment.
La enfermedad del suero (SS, por sus siglas en inglés) y las reacciones similares a la SS (SSLR) son entidades clínicas indistinguibles pero con procesos fisiopatológicos diferentes, particularmente respecto al impacto en el sistema del complemento. La base de datos VigiAccess™ sólo contiene 3 casos potenciales de SS entre 2890 registros para cefalotina reportados entre 1968 y diciembre de 2021, pero ninguno de SSLR. Este antibiótico de uso común fue aprobado en 1974, y sus primeros estudios clínicos describieron que la totalidad de voluntarios sanos podían producir SSLR dependiendo de la dosis y velocidad de infusión. Aquí presentamos el caso de una mujer joven, previamente sana, quien sufrió un accidente ofídico y se le administró antiveneno y cefalotina, tras lo cual desarrolló aparentemente SS, requiriendo re-hospitalización, pero debido a que no hubo consumo de complemento, y su recuperación fue total y sin complicaciones, se definió como una probable SSLR.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.