Therapeutic Segmental Pulmonary Lavage for Methanol Inhalation Poisoning in a Shrimp Processing Plant Worker: A Novel Approach to Toxic Inhalants.

Abstract

Inhalation of methanol vapor is a rare but potentially life-threatening occupational hazard, particularly in environments with inadequate ventilation and safety controls. We report the case of an 18-year-old male shrimp processing worker who developed acute respiratory failure following accidental inhalation of methanol vapors mislabeled as kerosene. The patient presented with severe dyspnea, hypoxemia, metabolic acidosis, and radiographic findings of diffuse pulmonary infiltrates. He required mechanical ventilation, corticosteroids, antibiotics, and intensive supportive care. Bronchoscopy revealed erythematous bronchial mucosa with hemorrhagic stippling and was followed by bronchoalveolar lavage (BAL). Based on imaging findings, therapeutic segmental pulmonary lavage (TSPL) was performed, targeting the most affected lower lobe segments. The procedure involved instillation and aspiration of small saline aliquots to remove inflammatory debris. Following TSPL, the patient exhibited marked clinical improvement, with normalization of inflammatory markers and successful extubation within 48 hours. This case illustrates the potential value of TSPL as an adjunctive therapy in methanol-induced chemical pneumonitis. Unlike standard BAL, TSPL enables targeted clearance of toxic exudates from specific lung segments, potentially accelerating recovery in patients with localized airway injury. Given the rarity of inhalational methanol poisoning and the absence of established respiratory interventions beyond supportive care, TSPL may offer a novel approach to managing severe pulmonary complications. This experience highlights the need for heightened clinical awareness of inhalational toxic exposures and further research into therapeutic lavage techniques. Our findings suggest that TSPL could be considered in selected cases of toxic inhalation injury when conventional measures fail to produce timely improvement.