A Case Report on Management of Paraquat Poisoning Associated with Oral Fibrosis and Lung Fibrosis

Abstract

Paraquat, a brown, viscous liquid herbicide known as “N, N’-dimethyl-4,4’-bipyridinium dichloride,” rapidly deactivates upon contact with soil, making it an efficient herbicide with minimal chronic toxicity. However, the prognosis is poor for acute poisoning or high doses of paraquat. Since, there is currently no effective treatment for paraquat poisoning, preventative efforts must be prioritised. A 31-year-old male patient was brought to the Emergency Department after ingesting around 10 mL of paraquat while under the influence of alcohol. He complained of vomiting, throat pain, mouth ulcers, and difficulty swallowing and speaking. Upon oral examination, erosions were observed on the upper and lower lips, with erythema present on the tongue. The patient was diagnosed with deliberate self-harm paraquat poisoning-induced oral fibrosis. Computed Tomography (CT) chest scan revealed no fibrosis except for a few paraseptal emphysematous changes in the apical segments of the bilateral upper lobes. Gastric lavage was performed, and activated charcoal (60 mg) was administered as initial treatment. The patient was then treated with choline salicylate gel, dexamethasone, and acetylcysteine as an anti-inflammatory measure for oral fibrosis before being discharged. However, the patient returned with complaints of dysphagia, worsened oral ulcers, and an inability to take oral fluids, leading to readmission for these issues. A follow-up CT chest scan revealed patchy ground glass consolidatory changes with surrounding minimal fibrotic changes in the bilateral upper lobe. The patient exhibited elevated levels of White Blood Cells (WBC), neutrophils, Erythrocyte Sedimentation Rate (ESR), urea, Blood Urea Nitrogen (BUN), and C-reactive Protein (CRP), which were continuously monitored. Due to the oral ulcers and lung fibrosis, the patient was treated with methylprednisolone, acetylcysteine, povidone iodine mouthwash, and clotrimazole mouth paint. The patient was managed conservatively, and there was an improvement in symptoms.

Keywords

• corticosteroids
• herbicide
• mouth ulcer
• paraseptal emphysema
• paraquat tongue
• povidone iodine mouthwash