LAUSR

Sir, We found the paper by Chen F et al. concerning a fatal case of homicidal paraquat poisoning with respiratory involvement, very interesting (1). The patient was initially misdiagnosed as pneumonia until the toxicological analysis of the cough syrup was performed after a high clinical suspicion of poisoning. Perhaps, however, a careful examination of the oral cavity should also have shown oropharyngeal injury like tongue ulcers in the setting of significant paraquat ingestion causing rapidly progressive respiratory failure. Paraquat is extremely corrosive and causes severe chemical burns of the gastrointestinal tract. Oropharyngeal necrosis and ulcerations are common and may be the only physical finding in first 12 h after toxin ingestion. Mucosal membranes damage may occur after brief oral exposures without swallowing. Extensive ulcerations can also be used as a predictor of involvement of lower gastrointestinal mucosa and significant systemic toxicity (2, 3). To illustrate, we describe two patients with intentional paraquat ingestion, who had characteristic tongue involvement and later died of lung toxicity.