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Failed rescue therapy with rapamycin after paraquat intoxication
Johan Matthes Lorenzen1, Eva Schonenberger, Carsten Hafer
1Department of Internal Medicine, Medical School Hannover, Hannover, Germany.
Clinical Toxicology (Philadelphia, Pa.)
|November 6, 2009
Summary
This case study shows that rapamycin failed to prevent fatal pulmonary fibrosis in a severe paraquat poisoning patient. Aggressive treatment, including rapamycin, did not halt the disease progression in this paraquat intoxication case.
Area of Science:
- Toxicology
- Pharmacology
- Pulmonology
Background:
- Paraquat ingestion causes irreversible pulmonary fibrosis, often leading to fatal outcomes.
- A 50-year-old male ingested a large quantity of paraquat (100g), presenting 15 hours post-ingestion with severe poisoning.
Observation:
- The patient received initial treatment with methylprednisolone and later antioxidative and anti-inflammatory therapies, including acetylcysteine and high-dose methylprednisolone.
- Despite aggressive interventions like extended daily dialysis and the introduction of rapamycin (8 mg/day) due to a 100% predicted mortality, paraquat levels remained high.
- Maximum rapamycin concentration reached 12.9 microg/L, but the patient developed severe pulmonary fibrosis.
Findings:
- Rapamycin, an antiproliferative agent, was administered 72 hours post-ingestion in an attempt to counteract paraquat toxicity.
- Despite the combination of therapies, including rapamycin, the patient succumbed to respiratory failure secondary to pulmonary fibrosis on day 18.
Implications:
- This case suggests that rapamycin may not be effective in halting the progression of severe paraquat-induced pulmonary fibrosis.
- Further research is needed to explore alternative or adjunctive treatments for paraquat poisoning, especially in severe cases with high mortality risk.
