Delayed immunosuppressive treatment in life-threatening paraquat ingestion: A case report

Abstract

Introduction: Combined glucocorticoids and cyclophosphamide pulse therapy showed promising results in moderate-to-severe paraquat poisonings to reduce life-threatening respiratory complications. Its benefit has been observed when given early in the course of poisoning; however, whether its delayed administration remains beneficial is unknown. Case Report: We describe a 23-year-old male who ingested 70 mL of a commercialized concentrate formulation with 20% weight/volume paraquat in a suicide attempt. Within 24 hours from paraquat ingestion, he presented most of the indicators of poor outcome, including gastritis, early renal dysfunction, dark blue urine colorimetric dithionite test, and marked plasma paraquat concentrations (0.56 μ/mL at 13 hours, and 0.41 μ/mL at 24 hours after ingestion). The patient received early gastrointestinal decontamination and aggressive supportive treatments. However, due to a rapidly progressive severe pulmonary infection, glucocorticoids and cyclophosphamide were delayed until day 14. Interestingly, our patient survived with mild respiratory sequelae despite poor initial prognosis. Discussion: This observation suggests the potential benefit of immunosuppressive pulse therapy, even if administered 14 days after paraquat ingestion, and highlights the role of paraquat-induced alveolitis in the development of fibrosis. Conclusion: Combined glucocorticoids and cyclophosphamide should be considered in moderate-to-severe paraquat poisonings, even if delayed.