Abstract
Paraquat is an effective herbicide widely used in India, but is highly toxic on human exposure. Cyclophosphamide is used as pulse therapy in combination with methylprednisolone for paraquat poisoning management. Neutropenia and thrombocytopenia are the main side effects which may occur with cyclophosphamide in cancer treatment due to bone marrow suppression. Hereby we report a rare case of cyclophosphamide-induced fatal cytopenia in a patient with paraquat poisoning. This is a case of 24 y old male who came to the emergency department of our hospital with a history of alleged consumption of 50 ml of paraquat liquid. On admission, he complained of pain and burning sensation in the throat and retrosternal region. Different treatment modalities, namely, pulse therapy with cyclophosphamide and methylprednisolone; and hemoperfusion were used to manage patient’s condition. Within few days, the patient developed severe neutropenia and thrombocytopenia. Despite several blood transfusions, the patient expired due to fatal manifestations of cytopenia.
Highlights
Paraquat is a widely used bipyridyl contact herbicide having good safety records on proper use
Mild poisoning in which patients develop minor and completely curable gastrointestinal symptoms; second is severe poisoning (20-40 mg paraquat ions/kg of body weight) in which patients develop acute renal failure, acute lung injury with progressive pulmonary fibrosis, respiratory failure leading to death in two to three weeks; third, fulminant poisoning (>40 mg paraquat ions/kg of body weight) in which death occurs because of multiple organ failures, within hours to a few days of consumption [5,6]
The literature suggests that pulse therapy with CP and methylprednisolone may be an effective and safe way to treat patients with moderate to severe paraquat poisoning
Summary
Paraquat is a widely used bipyridyl contact herbicide having good safety records on proper use. A short course of CP as pulse therapy in paraquat poisoning causing febrile neutropenia and thrombocytopenia together is a rare condition. In our knowledge, this is the first paraquat poisoning case being reported, where only 3 d of CP pulse therapy induced severe anemia, leucopenia and thrombocytopenia. A 24 y old male patient was admitted to the emergency department of Kasturba Medical College and Hospital, Manipal on 5th day of alleged selfconsumption of 50 ml of paraquat along with 50 ml of alcohol He experienced burning and pain in throat and retrosternal region. The patient seemed to be improving with respect to renal failure but succumbed to sepsis
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