Acute Lung Injury Following Inhalational Exposure to Trimethylsilyl Diazomethane: Case Series

Background: Trimethylsilyldiazomethane (TMSD) is a chemical reagent with recognised inhalational toxicity, although reports describing its clinical pulmonary effects remain limited. This case series describes the clinical and radiological manifestations, management, and short-term outcomes of four patients following accidental inhalational exposure to TMSD. Case Presentation: Four male patients aged 24–38 years developed respiratory symptoms after accidental occupational exposure to TMSD. Presentations included cough, chest tightness or pain, sore throat, breathlessness, and, in some patients, fever. Leukocytosis was observed in all four cases. Chest imaging demonstrated varying combinations of bilateral ground-glass opacities, centrilobular or peribronchiolar nodules, interstitial septal thickening, consolidation, and pleural effusions. The clinical diagnoses included acute inhalational lung injury and chemical pneumonitis, with respiratory failure documented in some patients. Management was predominantly supportive and included oxygen or ventilatory support when required, nebulisation, symptomatic treatment, and empirical intravenous antibiotics. Serial clinical and radiological assessment demonstrated progressive improvement, with substantial resolution of pulmonary abnormalities on follow-up imaging. All four patients were discharged in stable clinical condition. Conclusion: Acute TMSD inhalation was associated with a variable spectrum of pulmonary injury in these four patients. Recognition of the exposure history, respiratory monitoring, appropriate imaging, and supportive management were associated with favourable short-term clinical outcomes in this series.