Deadly Duality: Unravelling Pulmonary Thromboembolism in Paraquat Poisoning

Paraquat is a widely used herbicide as it is easily available. Accidental ingestion can cause high-case fatality. Even modest amounts of paraquat can be fatal. Poisoning can irritate the mouth, oropharynx and oesophagus. It also results in multiple organ failure. Pulmonary failure is the most common cause of death and lung fibrosis is the main respiratory complication in paraquat poisoning. Here, we report a rare case of paraquat poisoning presented with pulmonary thromboembolism. Our patient was already treated for paraquat poisoning and acute kidney injury with haemodialysis in an outside hospital. After 1 month, he came to our hospital with complaints of haemoptysis and shortness of breath. On further investigations, the patient was found to have a partial thrombus in the right common femoral vein and saddle embolism in the bifurcation of the right pulmonary artery extending into upper, middle and lower lobe branches. After ruling out all other causes, the reason for embolism was considered either due to paraquat poisoning per se or due to catheterisation for haemodialysis. The patient was started on anticoagulants. While treating the patient with paraquat poisoning, complications such as pulmonary thromboembolism due to haemodialysis or paraquat poisoning should also be considered.