Pulmonary histopathology in fatal paraquat poisoning

Kumar, Senthil; Gupta, Shikha; Bansal, Yogender Singh; Bal, Amanjit; Rastogi, Pulkit; Muthu, Valliappan; Arora, Vanshika

doi:10.4322/acr.2021.342

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Original Article • Autops. Case Rep. 11 • 2021 • https://doi.org/10.4322/acr.2021.342 copy

Pulmonary histopathology in fatal paraquat poisoning

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Paraquat is a potent herbicide widely used in the Indian agriculture industry. Human fatality due to paraquat poisoning is not uncommon in this country. The primary effect of paraquat is on the lungs, and the resultant pulmonary damage leads to the patient's demise. There is a high mortality rate in paraquat poisoning as the treatment is usually supportive with no known antidote. There are limited human studies that have observed the histopathological changes in lungs in paraquat poisoning. The authors have discussed the time-related histopathological changes in lungs in paraquat poisoning on autopsy subjects. The role of anticoagulants and fibrinolytic agents in the treatment of this poisoning has also been discussed.

Keywords
Paraquat; Acute toxicity; Autopsy; Histology; Lung injury

Lung histopathology findings observed in our case series of acute fatal paraquat toxicity
Pulmonary edema (15/17)^ǂ
Septal congestion (16/17) ^ǂ
Pulmonary hemorrhage (16/17) ^ǂ
Necrosis and denudation of type I pneumocytes (5/17) ^ǂ
Intra-alveolar hemosiderin laden macrophages (5/17) ^ǂ
Intra-alveolar infiltration of neutrophils/lymphocytes (10/17) ^ǂ
Hyaline membrane formation/Diffuse alveolar damage [DAD] (9/17) ^ǂ
Intra-alveolar fibrin deposition (6/17) ^ǂ
Intra-alveolar fibroblast proliferation/ collagen deposition [Masson’s body formation] (3/17) ^ǂ
Proliferation of type II pneumocytes (4/17) ^ǂ
Pulmonary artery thrombosis (3/17) ^ǂ
Honeycomb appearance (7/17) ^ǂ

Case#	ST	P.E	S.C	P.H	HLM	N/L	HM	I.A.F	I.A.F.C	H.C
13	1	+	+++	-	-	-	-	-	-	-
14	2	++	++	++	-	-	-	-	-	-
3	3	++	+++	+	-	-	-	-	-	-
16	3	+++	+++	+	+	N	-	-	-	-
17	3	+	++++	++++	-	N	-	-	-	-
15	3	+++	++++	++++	+	-	-	-	-	-
9	3	++	+++	++	+	N	-	-	-	-
2	4	++	++	++	-	N	+	-	-	-
6	4	+	++++	++++	-	N	++	+	-	-
10	4	++++	+++	+	++	N	-	-	-	+
12	6	+++	+	+	+	-	++	-	-	++
1	7	+	++	++++	-	-	+	-	-	-
7	7	++	++	+	-	L	+++	+	+	++
11	8	+	-	+++	-	-	++	+	-	++
5	9	-	++	+++	-	L	+++	+++	-	++
8	11	++++	++++	+	-	L	++	++	+	++
4	14	-	+	+	-	L	++	++	+++	+++

Hospital Universitário da Universidade de São Paulo Hospital Universitário da Universidade de São Paulo, Av. Prof. Lineu Prestes, 2565 - Cidade Universitária, 05508-000 - São Paulo - SP - Brasil, (16) 3307-2068, (16) 3307-2068 - São Paulo - SP - Brazil
E-mail: autopsy.hu@gmail.com

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[1] Authors’contributions: Senthil Kumar and Shikha Gupta collected and critically analyzed the data and drafted the initial manuscript. Initial review of histopathology slides were done by them along with Yogender Singh Bansal. Further, the pathological findings were reviewed and confirmed by Amanjit Bal and Pulkit Rastogi. Yogender Singh Bansal critically reviewed the slides and manuscript. Valliappan Muthu and Vanshika Arora reviewed the clinical files of the patient and critically reviewed the article. All the authors approved the final draft.