Case Report: Treatment of fulminant paraquat poisoning in a 32-week pregnant patient: a case report exploring the potential role of estrogen

Paraquat (PQ) poisoning is a life-threatening condition characterized by severe toxicity and the absence of a specific antidote. Prognosis is strongly correlated with the ingested dose, with high-dose exposure frequently resulting in multi-organ failure and fatal outcomes. This case report presents the clinical management of a 32-week pregnant patient with fulminant PQ poisoning, a scenario typically associated with near-certain mortality. Remarkably, the patient survived, supported by a markedly elevated peak serum estradiol level of 27,000 pg/mL, which may suggest a potential cytoprotective role of elevated estrogen levels, particularly in mitigating fatal pulmonary injury-a hallmark of PQ toxicity. Following an emergency cesarean section, the neonate also survived. Crucially, toxicological analysis via liquid chromatography-tandem mass spectrometry (LC-MS/MS) detected a trace PQ concentration of 1.3 ng/mL in the neonate’s blood. This finding provides definitive quantitative evidence of transplacental transfer and effectively explains the neonate’s transient hepatic and renal dysfunction. This report underscores the importance of individualized treatment strategies, including oral ulcer management, psychological support, and monitoring of the unique physiological changes during pregnancy. While maternal dynamic plasma PQ monitoring was absent in this case, the confirmed transplacental fetal exposure highlights the critical need for comprehensive maternal-fetal toxicological assessments in future studies.