Abstract Introduction Paraquat, a rapidly active herbicide can cause multiorgan dysfunction with a mortality rate of 40 - 80 %. Current clinical treatments for paraquat poisoning are only supportive and advancement of pulmonary disease is incurable in most cases. Case Report: A 12-year-old boy presented to intensive care unit with multiple episodes of vomiting and progressive breathlessness following accidental ingestion of approximately 50 mL of Paraquat. Initial evaluation showed renal and hepatic dysfunction and baseline respiratory parameters revealed tachycardia with SpO2: 84 % on room air. Immediate gastric lavage was performed, and hemoperfusion was initiated. Liver and renal parameters gradually normalized over a period of 10 days. Respiratory function continued to deteriorate requiring HFNC and HRCT thorax revealed progressive fibrotic lung injury. In view of worsening PaO2/FiO2 ratios, patient eventually required invasive mechanical ventilation, and subsequently, VV-ECMO was initiated on day 52 post-paraquat consumption. After multidisciplinary discussion by a team of pulmonologists, pediatric intensivist and thoracic surgeon, the option of bilateral lung transplantation was considered. Serial urine paraquat levels were negative prior to consideration for transplantation. After 2 months of paraquat ingestion, the patient underwent bilateral sequential lobar lung transplantation via bilateral anterolateral thoracotomy under ECMO support. Immunosuppression was initiated with steroid and mycophenolate mofetil (MMF), followed by maintenance triple immunosuppression (steroids, MMF and tacrolimus) along with prophylaxis for opportunistic infections. Patient was successfully decannulated from ECMO on post operative day 2 and gradually weaned off mechanical ventilation on post operative day 7. Three months post lung transplantation the patient is stable with good graft function and no evidence of rejection. Discussion This case represents the youngest reported survivor of lung transplantation for paraquat-induced pulmonary fibrosis. Lung transplantation remains the only definitive and effective therapeutic option for paraquat induced irreversible respiratory failure. The case underscores the importance of timely referral to a transplant centre, and a multidisciplinary approach. This abstract is funded by: None
Balasubramanian et al. (Fri,) studied this question.