Fatal paraquat poisoning by dermal exposure. Case report

Abstract

Introduction: Paraquat® is used for suicidal purposes because of its high lethality. Oral intake is the main way of consumption, and cases of ingestion by a cutaneous way are seldom seen and not commonly fatal. This report presents a case with severe systemic compromise and death after a dermal exposure to Paraquat®. Case overview: A female patient of 47 years old, single, housewife, of rural origins and an incomplete high school education, with a background of paraquat application in an ulcer, presented fever, vomiting, and general discomfort 24 hours after application. In the hospital, she presented generalized jaundice, acute renal failure, respiratory failure, progressive decay of her health, and death. She was remitted to a legal and medical autopsy. The findings of the autopsy ruled out oral ingestion and showed a hemorrhagic pancreas, congested kidneys, augmented hemorrhagic liver (2550 g), and an augmented heart. The histopathological studies showed a diffuse alveolar damage, (hyaline membranes, edema, and hemorrhage); pneumonia in lungs and visceral generalized congestion. Conclusion: The reported case is not only relevant because it shows an unusual intoxication of dermal paraquat ingestion, but also exposes two contributing problems for pesticide intoxication to occur: the availability and the lack of knowledge in use, management, and effects of these.