Report of a Case of Paraquat Poisoning and Mediastinal Involvement

Abstract

Paraquat has been recognized as a highly toxic agent for pest removal and is used worldwide. In adults, paraquat poisoning for suicidal attempts is much more common than accidental exposure poisoning. Approximately 20% of patients with paraquat poisoning develop pneumomediastonium as a complication with a mortality rate of approximately 100%. A 19-year-old man patient was admitted to the poisoning emergency department of Khorshid hospital, who had ingested paraquat. He had nausea and vomiting and had normal vital signs and examination in admission. Initial treatment for the patient was done. The patient signs got worsened on the 21 st day of hospitalization and had severe emphysema of the superficial and deep spaces of the neck, followed by bilateral pneumothorax, and severe pneumomediastinum. Unfortunately, the patient died on the 27 th day of hospitalization. Purpose of the current study is to raise awareness of rare paraquat toxicity complications, treatment, and especially its lethal complications, including pneumomomediastonium.

Lethal mediastinal emphysema caused by inhalation of PQ: A case report

“…Modes of exposure for poisoning include the gastrointestinal tract, respiratory tract, and skin contact [4] , with concentrated solution ingestion being the most common [5] . Here, the patient suffered from inhalation poisoning, which made identi cation challenging due to the absence of prominent indications of poisoning in the medical history.…”

A Tragic Outcome: Paraquat Poisoning in a Teenage Boy Using Marijuana

“…This uptake mechanism results in a lung parenchymal paraquat concentration that magnitudes surpass plasma levels by 10-20 times. 12 The impact on type 1 pneumocytes culminates in impaired oxygenation and capillary exchange, while type 2 pneumocytes experience augmented surface tension and ensuing fluid accumulation, provoking pulmonary oedema and haemorrhage. Subsequent recruitment of inflammatory cell infiltrates further aggravates the trajectory, fostering lipid peroxidation-triggered pulmonary fibrosis.…”

Paraquat Poisoning Associated With Daisley Barton Syndrome: A Case Report

“…Damage to type 1 pneumocytes impairs oxygenation and capillary exchange, whereas type 2 pneumocyte damage leads to increased surface tension and fluid accumulation, causing pulmonary edema and hemorrhage [ 11 , 12 ]. Pneumomediastinum may be caused by corrosion and esophageal perforation due to the corrosive effect of paraquat or by air leakage from ruptured alveoli along with peribronchial vascular structures [ 2 ]. In our case, there was pneumomediastinum of size 8.5mm initially and later, pneumothorax.…”

“…Paraquat poisoning has been reported worldwide, but only a few cases have been reported in India [ 1 ]. Paraquat (1,1′-dimethyl-4,4′-dipyridylium) is a toxic, corrosive liquid with a strong odor [ 2 ]. After ingestion, it mainly enters the lungs, liver, and kidneys [ 3 ].…”