Pneumoproteins as markers of paraquat lung injury: a clinical case.
OBJECTIVE
To describe the changes in lung-specific secretory proteins in biological fluids in a fatal case of paraquat ingestion and to present immunostaining data obtained on postmortem lung tissue specimens.


METHODS
A 20-year-old man committed suicide by ingesting 100ml of a 20% paraquat solution. Surfactant associated proteins A (SP-A), B (SP-B) and Clara cell 16kDa protein (CC16) were determined in the serum and on broncho-alveloar lavage performed 18h after admission. Renal failure progressed rapidly and the patient died from refractory hypoxia. Immunostaining studies using antibodies directed against CC16, SP-A and SP-B were performed on postmortem lung tissue specimens.


RESULTS
Serum CC16 seemed to increase gradually with the progression of renal impairment. Serum SP-A and SP-B levels increased before any significant changes in pulmonary gas exchanges. The immunostaining study showed that the labeling for SP-A and SP-B was reduced or absent following paraquat toxicity, while Clara cells were relatively preserved.


CONCLUSIONS
The elevation of serum CC16 with paraquat toxicity is probably mainly related to a reduced renal clearance. The increase of serum SP-A and SP-B could reflect an increased lung to blood leakage, independently of the alteration of the renal function.
Hantson
Philippe
P
Cliniques St Luc, Department of Intensive Care, Avenue Hippocrate 10, 1200 Brussels, Belgium. hantson@rean.ucl.ac.be
Weynand
Birgit
B
Doyle
Ian
I
Bernand
Alfred
A
Hermans
Cedric
C
D058186:Acute Kidney Injury / Q000139:chemically induced; D000328:Adult; D015415:Biomarkers / Q000032:analysis; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D003404:Creatinine / Q000097:blood; D055316:Cystatin C; D015891:Cystatins / Q000097:blood; D049429:Forensic Pathology; D053593:Forensic Toxicology; D006540:Herbicides / Q000506:poisoning*; D006801:Humans; D008168:Lung / Q000378:metabolism* / Q000473:pathology; D055370:Lung Injury; D008297:Male; D010269:Paraquat / Q000506:poisoning*; D037662:Pulmonary Surfactant-Associated Protein A / Q000097:blood; D037701:Pulmonary Surfactant-Associated Protein B / Q000097:blood; D014598:Uteroglobin / Q000032:analysis
D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D006540:Herbicides; D037662:Pulmonary Surfactant-Associated Protein A; D037701:Pulmonary Surfactant-Associated Protein B; C556389:SCGB1A1 protein, human; D014598:Uteroglobin; D003404:Creatinine; D010269:Paraquat