Complete pulmonary and renal recovery following severe paraquat poisoning: a six‑month radiological follow‑up and dynamic hematological observation.

backgroundParaquat poisoning is one of the most lethal toxicological emergencies, particularly in low- and middle-income countries. Despite several proposed treatment regimens, no single approach has conclusively demonstrated a reduction in mortality. Early clinical manifestations may be nonspecific, and prompt recognition in the emergency department is critical. We report the unexpected survival of a young woman who ingested a potentially fatal dose of paraquat, with emphasis on long‑term radiological follow‑up and dynamic hematological changes. CASE PRESENTATION: A 22‑year‑old Iranian woman presented to the emergency department approximately 48 h after reportedly ingesting 20 mL of a 20% paraquat solution in a suicide attempt. She had initially been evaluated at another facility shortly after ingestion but had refused admission against medical advice. She developed oropharyngeal mucosal ulcerations, odynophagia, hemoptysis, and acute kidney injury (peak serum creatinine 3.9 mg/dL). Laboratory data revealed a triphasic white blood cell pattern, including profound leukopenia followed by a marked rebound after granulocyte colony‑stimulating factor (G‑CSF) administration. A chest CT obtained at admission showed no pulmonary involvement; however, a follow-up CT performed on Day 14 demonstrated diffuse bilateral ground‑glass opacities and patchy consolidations consistent with acute alveolar injury. The patient received early multidisciplinary management including high‑dose corticosteroids, cyclophosphamide, antioxidant therapy, broad‑spectrum antibiotics, antimicrobial prophylaxis against opportunistic infections, nutritional support, and electrolyte correction. Clinical improvement was observed within 72 h, and she recovered without requiring dialysis or mechanical ventilation. A six‑month follow‑up chest CT showed complete radiological resolution with no evidence of pulmonary fibrosis.

conclusionsThis case suggests that complete pulmonary and renal recovery may be achievable in clinically severe paraquat poisoning. The six‑month imaging follow‑up documents the complete resolution of acute lung injury, while the dynamic leukocyte pattern illustrates the severity of bone marrow suppression and subsequent recovery. These findings highlight the potential value of early recognition, intensive multidisciplinary management, and structured follow‑up, particularly in resource‑limited settings.