Open AccessPneumomediastinum caused by occult paraquat poisoning
Author(s) -
Peng Deng,
Yao Chen,
Hong Li,
Zhi Gang Wan
Publication year - 2018
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000013745
Subject(s) - medicine , pneumomediastinum , occult , paraquat , poison control , medical emergency , surgery , pathology , pneumothorax , biochemistry , chemistry , alternative medicine
Rationale: Paraquat is a widely applied contact herbicide that is highly poisonous. About 20% of patients with paraquat poisoning develop pneumomediastinum as a complication with a mortality rate of almost 100%. Patient concerns: A 15-year-old boy presented with a 1-month history of retrosternal chest pain with no obvious cause. High-resolution computed tomography showed pneumomediastinum. Diagnoses: After all likely causes of pneumomediastinum were eliminated, the diagnosis of occult paraquat poisoning was made when serum paraquat concentration was revealed at 467.40 ng/mL, despite the patient's denial of ingestion or contact. Interventions: Hemoperfusion, intravenous glucocorticoid, and ulinastatin was administered for 3 days with other routine treatment against paraquat poisoning. The serum paraquat concentration decreased to zero. Outcomes: Despite the general high mortality and poor prognosis of paraquat poisoning, the patient recovered and was completely asymptomatic at his 3-month follow-up. Lessons: Paraquat poisoning should be suspected as a differential diagnosis when patients present with pneumomediastinum without recognizable cause.