Fulminant Paraquat Poisoning Leading to Spontaneous Pneumomediastinum: A Rare but Catastrophic Complication

Abstract

Paraquat (PQ) is a liquid herbicide commercially traded under the name “Gramoxone.” Human ingestion is uncommon but often fatal. Toxicity of PQ is mediated by the generation of reactive oxygen species which damages cell membranes. Apart from local corrosive damage to the gastrointestinal system, the lungs, liver, and kidneys bear the maximum damage. Rarely, PQ may present as spontaneous pneumothorax or pneumomediastinum or both. Herein, we present a case of fatal PQ poisoning where the patient developed pneumomediastinum on the 9th day with multiorgan dysfunction leading to his demise on 12th day. We also take this opportunity to briefly describe the pathogenesis of lung toxicity, the clinical manifestations, and various treatment strategies being explored in the different parts of the world, as no specific antidote is available till date.