Echec de la chimiothérapie et de la radiothérapie au cours des fibroses pulmonaires dues au paraquat

Abstract

A case is reported of severe interstitial paraquat poisoning in a 23 year old man. Initial treatment consisted of gastric lavage, fuller's earth, haemoperfusion on activated charcoal and peritoneal dialysis. On the third day, appeared both renal and early respiratory failure, with hypocapnia and hypoxia. Peritoneal dialysis was kept up to the thirteenth day. Pulmonary function tests showed a restrictive syndrome. Chemotherapy with 1 mg · kg −1 · 24 h −1 prednisone and 3 mg · kg −1 · 24 h −1 cyclophosphamide was started on day 4. Radiotherapy (13 Gy) was also given to both lung fields between days 6 and 10. Despite this treatment, respiratory failure worsened, and the patient died at the 28th day, with resistant severe hypoxaemia and pneumothorax on fibrous lungs. Several reports have shown conflicting results with chemotherapy and radiotherapy in the treatment of pulmonary fibrosis due to paraquat poisoning. The failure of such treatment in the case reported showed the need for large prospective clinical trials of the treatment of paraquat poisoning, as well as for urgent preventive measures.