An outbreak of fatal pneumonitis caused by contamination of illicit alcohol with paraquat.
BACKGROUND
We describe a series of unsuspected paraquat poisonings presenting as an outbreak of fatal acute pneumonitis. Exposure to paraquat occurred during the widespread practice of adding substances to alter the taste or potency of illicit alcohol. The diagnosis was suspected only after autopsy findings suggestive of paraquat toxicity were seen in the first fatality.


METHODS
An estimated 50 persons were exposed. Of these, 5 presented with ever and progressive dyspnoea, and died 9-30 days after exposure. We were able to trace 35 potentially exposed persons who survived, and compared them to the fatalities. Fever, headache, cough, dyspnoea, abdominal pain, hepatomegaly, and lung signs were more common among those who died. Autopsy revealed widespread renal and hepatic necrosis in the early deaths, and prominent pulmonary fibrosis in those dying later.


CONCLUSIONS
This case series defines an unusual syndrome of paraquat poisoning, which should be considered in the diagnosis of outbreaks of acute pneumonitis in illicit alcohol users.
Beligaswatte
Ashanka Mahilal
AM
University of Peradeniya, Department of Medicine, Peradeniya, Sri Lanka. ashanka.beligaswatte@yahoo.com
Kularatne
Senanayake A
SA
Seneviratne
Asoka B
AB
Wijenayake
M S Padmini
MS
Kularatne
W Keerthi
WK
Pathirage
L Manoji
LM
D000208:Acute Disease; D000328:Adult; D001344:Autopsy; D056486:Chemical and Drug Induced Liver Injury; D003415:Crime; D003937:Diagnosis, Differential; D004196:Disease Outbreaks; D004340:Drug Contamination; D004417:Dyspnea / Q000139:chemically induced; D000431:Ethanol / Q000737:chemistry / Q000633:toxicity*; D006540:Herbicides / Q000032:analysis / Q000633:toxicity*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced / Q000473:pathology; D008107:Liver Diseases / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010269:Paraquat / Q000032:analysis / Q000633:toxicity*; D011014:Pneumonia / Q000139:chemically induced* / Q000401:mortality / Q000473:pathology; D011658:Pulmonary Fibrosis / Q000139:chemically induced / Q000473:pathology; D012141:Respiratory Tract Infections / Q000175:diagnosis; D013188:Sri Lanka; D013997:Time Factors
D006540:Herbicides; D000431:Ethanol; D010269:Paraquat