Survival after paraquat poisoning in a HIV positive patient

Abstract

<jats:p> From 1987 to 1994, 31 cases of acute paraquat poisoning were managed in the CHRU of Pointe à Pitre (FWI). Eighteen patients died, 13 survived. Biological indexes accurately predicted patient's outcome in all cases out of one. In the last case biological parameters were mislead ing : the corresponding patient survived despite consistent clinical and biological prognosis of death. The unexpected survivor was West Indian, male, agricultural worker of 26 years who alleged drunk about 300 ml of gramoxone (20% v/v paraquat) in a suicide attempt. The patient was HIV infected (Elisa+, Western-Blot+) and presented an AIDS syndrome (CD4 count inferior to 200 cells/mm<jats:sup>3</jats:sup>) estab lished since 10 months and treated by AZT. We could not identify any other distinguishing features among the unexpected survivor and the rest of the patients. This observation suggests that the immunological status of the patient could explain this protection from paraquat toxicity </jats:p>

Paraquat Poisoning in Patients With HIV Infection

“…3 The second case was reported this year by An-Dong Shang et al 3 in which they describe a 34-year-old man with HIV infection and severe PQ poisoning. In contrast to the first case 2 and our case, the patient received the current standard treatment, including HP, MTP, and CTX. He also survived with a good outcome despite the high serum concentration of PQ.…”

“…After performing an extensive search of the literature, only 3 cases of HIV patients with PQ poisoning were reported in PubMed (including the present case) 2,3 (summarized in Table 1). The first study regarding PQ poisoning in an HIV patient was reported by Ragoucy-Sengler et al 2 who described a 26-year-old HIV positive man with severe paraquatemia.…”

“…The first study regarding PQ poisoning in an HIV patient was reported by Ragoucy-Sengler et al 2 who described a 26-year-old HIV positive man with severe paraquatemia. He also suffered from hypoxia, dyspnea, and AKI.…”

HIV and paraquat poisoning: fighting fire with fire?

“…The first case was reported by Ragoucy-Sengler and Pileire (1996). This HIV-infected patient (with a serum concentration of 1.3 µg/ml PQ, five hours after exposure) survived after receiving lavage and diuresis, in spite of clinical and biological prognoses of death.…”

“…Only three cases of HIV patients with PQ poisoning are listed in PubMed (Ragoucy-Sengler and Pileire, 1996;Shang and Lu, 2015;Tsai et al, 2016). Fortunately, they all had excellent outcomes.…”