A Case Report of Severe Paraquat Poisoning in an HIV-Positive Patient

Abstract

We described and analyzed the treatment process of an HIV-positive patient with severe paraquat (PQ) poisoning.A 34-year-old man ingested about 50 mL of a 20% solution of PQ in a suicide attempt. He was treated with gastric lavage, oral administration of adsorbent, and symptomatic treatments at the local hospital, and was transferred to our emergency department. Ten hours after the exposure, the concentration of plasma PQ was 2.17 mg/L and was substantially above the survival limits of the severity index for PQ poisoning (SIPP) curve (0.30 mg/L). The equation produced by Jones et al (Jones AL, Elton R, Flanagan R. Multiple logistic regression analysis of plasma paraquat concentrations as a predictor of outcome in 375 cases of paraquat poisoning. QJM. 1999:92;573–578) predicted a 20.5% probability of survival at admission. Unfortunately, the patient was diagnosed as HIV infected, and CD4+ lymphocyte count also confirmed that the patient was in a state of mild suppression of immunological function.Immediately, the patient received normative immunosuppressive therapy and hemoperfusion (HP). On the 15th day after poisoning, the patient recovered well and was discharged.All along, the evolution of the patient's status was in accordance with the characteristics of PQ poisoning, but the extent and duration of damage was mismatching and drastically alleviative by the previous biological indices. The particular case of treatment may be indirectly supporting the effectiveness of immunosuppressive therapy in treating patients with PQ poisoning.

HIV and paraquat poisoning: fighting fire with fire?

“…The recovered HIV patients tended to suffer much less lung injury than the general PQpoisoned patients. In addition, they all had low CD4 + T lymphocyte levels due to HIV infection (RagoucySengler and Pileire, 1996;Shang and Lu, 2015;Tsai et al, 2016). These low counts of CD4 + T lymphocytes confirmed that the patients were in an immunosuppressed condition, which may be conducive to relieving the acute inflammation and lung fibrosis induced by PQ.…”

“…This HIV-infected patient (with a serum concentration of 1.3 µg/ml PQ, five hours after exposure) survived after receiving lavage and diuresis, in spite of clinical and biological prognoses of death. Our team reported the second case of a 34-year-old man who had HIV infection and severe PQ poisoning (Shang and Lu, 2015). He survived with a good outcome despite a usually fatal serum concentration of PQ (2.17 µg/ml, ten hours after exposure) after receiving immunosuppressive therapy and HP.…”

“…Only three cases of HIV patients with PQ poisoning are listed in PubMed (Ragoucy-Sengler and Pileire, 1996;Shang and Lu, 2015;Tsai et al, 2016). Fortunately, they all had excellent outcomes.…”

Evaluation of efficacy of resin hemoperfusion in patients with acute 2,4-dinitrophenol poisoning by dynamic monitoring of plasma toxin concentration

“…Certainly, it can simultaneously maintain electrolyte balance, control body temperature, and protect the liver and kidney. Moreover, resin HP has successfully treated some patients who have overdosed on highly lipid solubility drugs (Licari et al, 2009;Sikma et al, 2012;Zhang et al, 2012;Brandenburg et al, 2014;Shang and Lu, 2015). Such poisoning accidents were rare and are clinically critical, and it was difficult to perform a well-controlled study.…”

Use of Tripterygium wilfordii Hook F for immune-mediated inflammatory diseases: progress and future prospects

“…Paraquat poisoning-induced acute lung injury is thought to be associated with a strong and persistent inflammatory response Feng et al, 2018;Xu and Lu, 2019). Our group has reported that an acquired immune deficiency syndrome (AIDS) patient who ingested a lethal dose of paraquat had a good prognosis (Shang and Lu, 2015). Patients with AIDS are known to have immunodeficiency, whose immune system is suppressed, and that case could indirectly support the effectiveness of immunosuppressive therapy in treating patients with paraquat poisoning (Lu, 2018).…”