Case Report

Rapid Successful Management of Diffuse Alveolar Hemorrhage as the Primary Presentation of Chlorine Gas Inhalation: A Rare Case Report

Abstract

Chlorine-containing bleach, as a common disinfectant, can cause mild to severe symptoms from nasal irritation to life-threatening conditions such as acute respiratory distress syndrome (ARDS). However, the toxicity level of chlorine gas depends on the duration and concentration of exposure. Herein, we describe the case of a 44-year-old man admitted to the emergency department with a chief complaint of severe shortness of breathing and hemoptysis following accidental, short-time exposure to chlorine-containing bleach. Because of the life-threatening condition, he was transferred to the Intensive Care Unit (ICU) and received mechanical ventilation along with a corticosteroid agent and antibiotic therapy. Despite limited data on management of the severe complications of the exposure, the patient successfully recovered after four days.

1. Shin H-J, Chang J-S, Ahn S, Kim T-O, Park C-K, Lim J-H, et al. Acute respiratory distress syndrome and chemical burns after exposure to chlorine-containing bleach: a case report. Journal of thoracic disease. 2017;9(1):E17.
2. Babu RV, Cardenas Jr V, Sharma G. Acute respiratory distress syndrome from chlorine inhalation during a swimming pool accident: a case report and review of the literature. Journal of intensive care medicine. 2008;23(4):275-80.
3. Parimon T, Kanne JP, Pierson DJ. Acute inhalation injury with evidence of diffuse bronchiolitis following chlorine gas exposure at a swimming pool. Respiratory care. 2004;49(3):291-4.
4. Mapp C, Pozzato V, Pavoni V, Gritti G. Severe asthma and ARDS triggered by acute short‐term exposure to commonly used cleaning detergents. European Respiratory Journal. 2000;16(3):570-2.
5. Wang L, Wu D, Wang J. Chlorine gas inhalation manifesting with severe acute respiratory distress syndrome successfully treated by high-volume hemofiltration: a case report. Medicine. 2018;97(30).
6. White CW, Martin JG. Chlorine gas inhalation: human clinical evidence of toxicity and experience in animal models. Proc Am Thorac Soc. 2010;7(4):257-63.
7. Park MS. Diffuse alveolar hemorrhage. Tuberculosis and Respiratory Diseases. 2013;74(4):151-62.
8. Baumgartner M, Ashton R. Diffuse alveolar hemorrhage. Southern medical journal. 2011;104(4):274.
9. Shen M, Zeng X, Tian X, Zhang F, Zeng X, Zhang X, et al. Diffuse alveolar hemorrhage in systemic lupus erythematosus: a retrospective study in China. Lupus. 2010;19(11):1326-30.
10. Abdalla AO, Al-Khafaji J, Akella PM, Taha M. A fatal case of diffuse alveolar hemorrhage as the initial presentation of systemic lupus erythematosus: A case report and literature review. Respiratory medicine case reports. 2018;24:55-7.
11. Schönhofer B, Voshaar T, Köhler D. Long-term lung sequelae following accidental chlorine gas exposure. Respiration. 1996;63(3):155-9.
12. Lara AR, Schwarz MI. Diffuse alveolar hemorrhage. Chest. 2010;137(5):1164-71.
13. Bosse GM. Nebulized sodium bicarbonate in the treatment of chlorine gas inhalation. Journal of Toxicology: Clinical Toxicology. 1994;32(3):233-41.
14. Chester EH, KaimaL PJ, Payne Jr CB, Kohn PM. Pulmonary injury following exposure to chlorine gas: possible beneficial effects of steroid treatment. Chest. 1977;72(2):247-50.
Files
IssueVol 59, No 10 (2021) QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/acta.v59i10.7770
Keywords
Diffuse alveolar hemorrhage (DAH) Acute respiratory distress syndrome (ARDS) Chlorine gas inhalation Corticosteroids

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How to Cite
1.
Yaghubi M, Valaei M, Ghasemi R, Hosseinzadeh Maleki M, Rezaei S, Kakhki S. Rapid Successful Management of Diffuse Alveolar Hemorrhage as the Primary Presentation of Chlorine Gas Inhalation: A Rare Case Report. Acta Med Iran. 2021;59(10):617-620.