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Mercury, a ubiquitous heavy metal, poses a significant threat to human health. Intravenous mercury poisoning is an uncommon but critical medical emergency. The nature and severity of its toxic effects depend on the form of mercury encountered: elemental, inorganic, or organic. It can affect almost all organ systems in the body. Chelating agents are the primary treatment for symptomatic mercury poisoning. This case report is about a 27-year-old male patient who presented to the emergency department with an alleged history of intravenous injection of mercury as an attempt at suicide, followed by breathlessness, chest pain, vomiting, and high-grade fever. He was managed with chelating therapy, non-invasive ventilation, and other supportive measures and was discharged home. After five days of discharge, he presented with fever and rashes and was diagnosed with toxic epidermal necrolysis (TEN). In spite of all aggressive management, he succumbed to death after four days of re-admission. Early intervention can significantly improve the chances of recovery. However, even with successful treatment, some individuals may experience long-term complications.

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Lipoid pneumonia is defined as a type of pneumonia that occurs as a result of inhalation of either endogenous or exogenous lipid-containing products in the lungs. We present the case of a 55-year-old male patient who presented with chief complaints of cough with blood-tinged sputum, right-sided chest pain, dyspnea, and fever for two days. The patient gave a history of working as a mechanic in an automobile garage and reported an episode of accidental aspiration of diesel during diesel siphoning at the workplace. A chest X-ray and computed tomography (CT) scan of the chest were done, which revealed right-sided lower lobe consolidation. The patient was admitted and started on intravenous antibiotics, corticosteroids, and inhaled bronchodilators, along with oxygen support. A bronchoscopy was done, which revealed the presence of thick mucoid secretions in the right lower lobe bronchus. The patient was discharged after 10 days with stable vitals and was advised to have regular follow-ups to monitor for any long-term pulmonary complications.

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Background: Auxiliaries, a mixed chemicals, for printing and dyeing characterized by their diverse range and complex chemical compositions are commonly utilized in the textile industry. These chemicals can lead to environmental contamination and pose health risks to humans. Case Description: A 29-year-old man who worked in a printing and dyeing factory in Suzhou, China, reported having tightness in his chest and coughing. Despite seeking medical treatment at several hospitals, the initial diagnosis remained elusive. High-resolution chest CT scans showed multifocal lesions in both lungs. The patient had no significant medical history, and the respiratory symptoms only surfaced after exposure to dyeing auxiliaries. Physicians initially suspected chemical pneumonitis due to occupational exposure. However, a subsequent evaluation at a hospital specializing in occupational diseases led to a diagnosis of AIDS and pneumocystis pneumonia. Conclusion: This case underscores the importance of comprehensive clinical diagnosis to avoid biases and reduce the incidence of misdiagnosis.

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The optimal treatment of acute chemical pneumonitis remains controversial. Here we report a healthy man with severe chemical pneumonitis caused by accidental inhalation of vanadium pentoxide. He presented with acute respiratory distress and received aggressive steroid therapy on arrival. Pulmonary symptoms and chest X-ray were improved dramatically the next day. The beneficial effect of steroid therapy for such a critical patient may outweigh the infection risk following inhalation of relative sterile material. We suggest early and aggressive steroid therapy may help shorten the disease course.

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Tracheoesophageal fistula (TEF) with or without associated esophageal atresia (EA) in the neonate is challenging to diagnose and manage its complications like aspiration, respiratory distress, and other associated anomalies. To stabilize, ventilate and prepare for surgical correction, understanding the H-nature of disease and anticipation of problems and their management will improve survival. We present a newborn with tracheoesophageal fistula without atresia from resource-limited settings and lessons we learned from the case.

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Chemical pneumonitis caused by dimethanol and glutaraldehyde exposure is a serious medical condition that requires prompt and effective treatment. As per a literature search in Google Scholar, PubMed, and Scopus, this is the first instance of chemical pneumonitis caused after fumigation with dimethanol and glutaraldehyde inhalation. This article discusses the factors that can contribute to the development of chemical pneumonitis and outlines the diagnostic and treatment options available to healthcare professionals. By understanding the causes and consequences of dimethanol- and glutaraldehyde-induced chemical pneumonitis, medical professionals can provide better care to their patients and help prevent future cases of this potentially life-threatening condition. This describes a case of a 60-year-old female who presented to the emergency department complaining of acute onset of shortness of breath approximately 48 hours after being exposed to dimethanol and glutaraldehyde while working in intensive care. After 13 days, the patient's symptoms subsided and she was discharged. On follow-up, after 1 month, there was a marked resolution of the initial symptoms.

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Inhalation of acid fumes and aspiration of liquid substances or gastric contents may not initiate dyspnea within several hours after exposure but may result in delayed onset of alveolar edema. The present report presents three cases of inhalation or aspiration of chemical substances that resulted in acute respiratory distress syndrome (ARDS). Due to different underlying reasons, three patients developed ARDS resulting from chemical pneumonitis and pulmonary infection. From patients with dyspnea, dry rales could be heard in both lungs, with <92% percutaneous oxygen saturation at room air. All patients were treated using a high-flow nasal cannula and sivelestat sodium. Oxygenation gradually improved and the patients were discharged without adverse events. These cases suggest that early treatment with sivelestat sodium may improve the clinical outcomes of patients with ARDS.

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Diesel fuel aspiration can occasionally result in an uncommon but potentially deadly condition called chemical pneumonitis. Case presentation: In this case study, a 16-year-old boy gave a history of diesel fuel siphoning from a motor vehicle tank, which brought him to our emergency room. He complained of coughing, breathing difficulties, and chest discomfort upon admission to the hospital. Patchy bilateral parenchymal lung opacities consistent with acute chemical pneumonitis were seen in radiological imaging tests. Treatment included supportive care, oxygen supplementation, and intravenous antibiotics. The patient's symptoms improved gradually throughout his hospitalization, and he was eventually discharged home with a good prognosis. Clinical discussion: Siphoning is a common practice in developing countries like Bangladesh. Workers at automobile transfer hydrocarbon products from one vehicle to other. However, its aspiration can cause a pneumonia like features and may wrongly misdiagnose. Diagnosis is made mainly on history taking. Conclusion: Physicians ought to know that patients exposed to diesel fuel may develop chemical pneumonitis, and they should consider this for an early diagnosis and effective treatment that can lead to favourable outcomes.

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Hydrogen peroxide is a chemical commonly used as a household antiseptic for cleaning and disinfecting. No cases of acute hydrogen peroxide inhalation-induced lung injury are previously described. We present a case of acute chemical pneumonitis caused by mixing hydrogen peroxide in a nighttime continuous positive airway pressure device's humidifier used for obstructive sleep apnea to prevent COVID-19 infection. The patient endorsed mixing hydrogen peroxide with distilled water in his nighttime continuous positive airway pressure device's humidifier at a ratio of 1:3-1:2 for the previous week before admission based on a friend's advice in preventing COVID-19. The presenting chest X-ray showed new multifocal consolidations with interstitial markings and alveolar edema throughout both lungs. Chest computed tomography (CT) imaging demonstrated multifocal, bilateral, hazy consolidations with increased interstitial markings and bilateral pleural effusions. The patient was subsequently initiated on systemic glucocorticoid therapy, significantly improving hypoxemia and dyspnea. Inhalation of hydrogen peroxide may produce acute pneumonitis distinct from what has been described previously with chronic inhalation. Given this case, systemic glucocorticoid therapy may be considered a viable treatment option for acute hydrogen peroxide-associated inhalation lung injury causing pneumonitis.

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Introduction: The use of household cleaning agents as a method of self-harm has been reported in the literature frequently. However, reports of Harpic ingestion a commonly used toilet cleaner is significantly lacking. Due to the ease of access of household cleaning agents, people tend to choose it as quick method of self-harm. The main focus after ingestion of acid is on the digestive tract injury. But due to the tendency to vomit after ingestion of such substance and inhalation of fumes generated there is a high possibility of injury to the respiratory tract as well. Case presentation: Here we present a case of 19-year-old female with injury to the aerodigestive tract presenting with stridor after ingestion of Harpic - a hydrochloriacid-based cleaning solution. In addition to the gastric mucosal injury a diagnosis of chemical pneumonitis was made and her airway was protected in time for her to have a good recovery. Discussion: Inducing vomiting in patients with hydrochloric acid is not advised because it can increase the risk of pulmonary complications as a result of aspiration [8]. Moreover, blind insertion of a nasogastric (Ryle's) tube is not done due to the risk of perforation and induction of regurgitation or vomiting. In few cases steroids have also been tried with no promising results [9]. Since there are no therapeutic standards for caustic injuries, treatment centers on correcting metabolic imbalances, coagulopathy, and emergency surgical intervention for severe injury and late sequelae. However, it is crucial to watch out for aspiration and respiratory tract injury and perform timely protection of the airway. Conclusion: An awareness of the potential impacts of acid ingestion on the respiratory tract with a high level of suspicion towards airway injury and timely protection of airway is crucial for proper management of the patient.

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Acute respiratory illness caused by exposure to welding-associated zinc oxide fumes is known as metal fume fever (MFF). MFF is generally characterized as a self-limiting disease. Few studies have reported chemical pneumonitis associated with zinc fume inhalation. We report a case study involving severe episodes of MFF accompanied by chemical pneumonitis due to the inhalation of zinc oxide fumes while operating an arc welder. A 54-year-old man developed flu-like symptoms after arc welding galvanized steel in a poorly ventilated area. Despite intravenous antibiotics therapy, his clinical course worsened, and his urine zinc concentration was remarkably elevated (3579 µg/24 h; reference range, 0-616 µg/24 h). A chest computed tomography revealed extensive consolidation, ground-glass opacity in the lungs, and right pleural effusion. After corticosteroid treatment, the patient's symptoms and radiologic findings significantly improved. It should be noted that the inhalation of zinc oxide fumes can occasionally induce acute lung injury via inflammatory responses and oxidative stress.

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Acute lipoid pneumonia is quite uncommon and is associated with oily or lipid contents within the alveoli. Exogenous lipoid pneumonia due to kerosene poisoning, manifests with a wide clinical spectrum ranging from subtle chemical pneumonitis to marked severe pulmonary and systemic inflammation. We present an interesting case of an adult male with kerosene poisoning. He manifested with severe cavitating lung disease. In addition, he developed spontaneous pneumothorax. Both cavitating lung disease and pneumothorax are unusual manifestations of acute exogenous lipoid pneumonia and perhaps follow severe lung injury following high volume kerosene exposure.

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The intentional liberation of carbon monoxide through the dehydration of formic acid has been reported with increasing frequency in the literature as a method of self-harm. Online forums have popularized this method of self-harm due to the ease of access of the required reagents, as well as the ability to perform the reaction under ambient conditions. The basis of this method of suicide is the use of sulfuric acid as a dehydrating agent, leading to the decomposition of formic acid into carbon monoxide gas. In addition to the exposure to carbon monoxide liberated by this reaction, the relatively high vapor pressure of formic acid can inadvertently lead to its inhalation and subsequently cause damage to the aerodigestive tract. We report a 21-year-old male who presented with manifestations of acute carbon monoxide poisoning and concomitant chemical pneumonitis. Increased awareness and understanding of this method of self-harm is critical in ensuring appropriate precautions are taken when caring for these individuals.

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We present the case of an 80-year-old woman with Mendelson's syndrome complicated by bacterial aspiration pneumonia caused by consciousness loss followed by vomiting resulting from putamen bleeding. Her condition worsened rapidly to develop respiratory failure, within a few hours; thereafter, she was intubated. Streptococcus agalactiae and Klebsiella oxytoca were detected from the aspirated sputum sample culture. She was diagnosed with acute respiratory distress syndrome with Mendelson's syndrome complicated by bacterial aspiration pneumonia. Corticosteroid and antibiotic administration improved her condition and led to successful extubation; therefore, these treatment modalities were invaluable. We suggest the clinical considerations for the corticosteroid and antibiotic use in such cases.

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Hydrogen Fluoride (HF) inhalation is one of the industrial accidents. It causes serious damage, although it is quickly recognized. Since hydrofluoric acid leaks are under surveillance by the alarm system, and low concentrations of gas also have a distinctive smell, most accidents occur from exposure in a short period to a large amount of HF. Thus, prolonged exposure to HF is exceedingly rare in a developed country. We report seven cases of chemical pneumonitis due to HF inhalation to share clinical course and prognosis.

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E-cigarette-and vaping-associated lung injury (EVALI) is a new diagnosis with at least 2,807 hospitalizations and 68 deaths since 2019. This clinical observation describes one of the first cases of EVALI in a teenager who presented with nic-sick symptoms and developed acute respiratory distress syndrome and pneumomediastinum. The manuscript also reviews the presentation, work-up, recommended management, and proposed etiology of the condition and summarizes recent national vaping regulations enacted to address the EVALI epidemic.

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Acute accidental inhaled benzene toxicity is rare; however, it associates with the complications including chemical pneumonitis frequently and rarely with the cardiac and neurological complications. The patient should be treated symptomatically since there are no specific clinical practice guidelines especially antidotes established in this regard. The follow-up and monitoring of the patient are crucial for the remission and also to rule out further complications.

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Exogenous lipoid pneumonia (ELP) is an uncommon cause of respiratory distress. The practice of oil massage and oil instillation into the nostrils is common in the Indian subcontinent. Accidental aspiration of baby oil may lead to significant chemical pneumonitis. This presentation may vary from subtle to severe respiratory distress requiring intensive care management. Spontaneous air leaks are rare in acute ELP. We successfully managed a six-month-old girl presenting with mineral oil-induced ELP and air leaks. However, these children require long-term follow-up, as a small proportion may evolve into chronic lung disease.

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Ingestion of hydrocarbons is a common cause of childhood poisoning in low and middle-income countries. Although mild ingestions are usually devoid of complications, the morbidity and mortality associated with such poisoning are primarily related to pulmonary aspiration. Subsequent complications, most importantly, secondary bacterial infections can worsen the clinical condition. Standard treatment protocol for acute accidental hydrocarbon poisoning does not advocate routine use of steroids or antibiotics. However, some studies have demonstrated beneficial effects of prophylactic steroid and antibiotic to prevent chemical pneumonitis. In this article, we have summarized the findings of the clinical studies from literature, which have evaluated the advantages of early administration of steroids and antibiotics to prevent chemical pneumonitis in acute hydrocarbon poisoning in children. From these studies, we have found that there is no convincing evidence for initiating steroid and antibiotic to improve outcome in these children.

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