Acute Respiratory Failure of Unknown Etiology After Charcoal-Burning Suicide Attempt: Suspected Hypersensitivity Pneumonitis

Abstract

We report a case of a 25-year-old man who presented to the emergency department with respiratory distress after attempting suicide using burning charcoal briquettes. Charcoal briquette suicide is a method of suicide by carbon monoxide poisoning through inhalation of carbon monoxide produced when charcoal briquettes are burned. The patient had a history of childhood asthma, but he was not on any scheduled treatment regimen. Upon admission, he had an elevated respiratory rate, hypoxic respiratory failure, and bilateral respiratory wheezing. Computed tomography showed significant mottled and infiltrated shadows in the upper lobes of both lungs, and hypersensitivity pneumonitis was suspected. Sputum culture, autoantibodies such as antinuclear antibodies, and other diagnostic tests ruled out other conditions. The patient was treated with antibacterial agents and steroids. Imaging tests showed improvement over time. He was discharged on the seventh day. Charcoal briquette is a rare antigen that can potentially trigger hypersensitivity pneumonitis. Physicians should consider hypersensitivity pneumonitis as the differential diagnosis of respiratory failure after a charcoal-burning suicide attempt.

Keywords: attempted suicide; charcoal; extrinsic allergic alveolitis; pneumonia; respiratory failure.

Figure 1. Chest computed tomography at the time of arrival

A: axial view. B: coronal view.

Figure 2. Chest X-ray images at the initial visit and after treatment