A Case of Paraquat Poisoning Presenting With Spontaneous Pneumothorax and Pneumomediastinum

Abstract

Paraquat (1,1'-dimethyl-4,4'-dipyridylium) is a liquid herbicide associated with accidental and suicidal ingestion, leading to fatal toxicity. It can lead to multiple organ dysfunction, including metabolic acidosis, acute kidney and liver injury, pulmonary fibrosis, and acute respiratory distress syndrome (ARDS). Very rarely, this can present with spontaneous pneumothorax or pneumomediastinum or both, which are poor prognostic markers with a mortality rate of almost 100%. Here, we present a young male presenting with paraquat poisoning followed by the development of both pneumothorax and pneumomediastinum and death from respiratory failure. Paraquat poisoning should always be considered in the differential diagnosis in patients presenting with spontaneous pneumothorax or pneumomediastinum in places with high paraquat poisoning prevalence.

Keywords: paraquat; pneumothorax; pulmonary fibrosis; reactive oxygen species; spontaneous pneumomediastinum.

Figure 1. Diffuse fibrotic changes in bilateral lung fields

Figure 2. CT thorax showing pneumothorax, pneumomediastinum, and subcutaneous emphysema

CT: computed tomography

Figure 3. Continuous diaphragm sign in pneumomediastinum