Successful Management of Fatal Paraquat Poisoning with Four Courses of Steroid and Cyclophosphamide Pulse

Although severe paraquat poisoning is fatal, intensive immunosuppression can be successful in selected patients. We report the case of a 33-yr-old patient who was poisoned by paraquat and developed multi-organ failure, progressive hypoxemia, and pulmonary fibrosis. The patient was successfully treated with four courses of immunosuppressive pulse therapy. The patient presented to the hospital 2.5 hours after ingesting 2 mouthfuls of paraquat. The serum level of paraquat was $10.40\;{\mu}g/mL$ at 3 hours and $3.36\;{\mu}g/mL$ at 10 hours after ingestion, which is predictive of a fatal outcome. The first course of steroid and cyclophosphamide pulse therapy was initiated after hemoperfusion. During the hospital course, the patient showed progressive hypoxemia with pulmonary fibrosis. Accordingly, three additional courses of immunosuppressive pulse therapy were administered to prevent pulmonary injury. This treatment inevitably led to bone marrow suppression, which was recovered with supportive care. The patient fully recovered after repeated immunosuppressive pulse therapy without residual hypoxemia and was successfully discharged from the hospital.

4회의 면역 억제제 펄스 치료로 생존한 치명적 농도의 파라캇 중독 1예

저자들은 치명적인 혈중 파라캇 농도($10.4\;{\mu}g/mL$)를 보여 주면서 다발성장기부전 및 폐 섬유화에 의한 저산소증이 병발하여 생존 가능성이 극히 희박했던 중증 파라캇 중독 환자에서 골수기능억제가 나타날 정도까지 선제적이고 적극적으로 4차례의 스테로이드와 시클로포스파미드 펄스 면역 억제치료를 반복하였고, 치료 경과 중 면역 억제제로 인한 심각한 골수기능억제와 감염 등의 합병증이 발생하였으나 포기하지 않고 적극적인 치료를 시행하여 환자를 생존시켰기에 문헌고찰과 함께 보고하는 바이다.