Respiratory Distress Caused by Salicylism Confirmed by Lung Biopsy

For decades, salicylates have been recognised as one of the leading causes of drug overdoses. Deaths attributable to salicylates alone can be as high as 20.6% per year of analgesic drug deaths.[1] The incidence of salicylate poisonings, especially those with a chronic component, is difficult to ascertain because of the under-reporting of such cases and the poor correlation with serum levels. However, it is perceived to be low and usually occurs in patients with chronic pain.[2] Classic signs and symptoms in mild cases of acute salicylate toxicity include tachypnoea, lethargy, vomiting and hyperthermia without overt acidosis. In severe cases, symptoms worsen and, in addition, the patient may have metabolic acidosis and/or coma.[3] These symptoms correlate with the Done nomogram, which is used to assess the severity of acute salicylate poisoning.[4] Unfortunately, the severity of chronic salicylate overdoses is difficult to determine since serum concentrations do not accurately correlate with the Done nomogram.[5] Data illustrating the clinical ramifications of mixed acute and chronic intoxication of salicylates are scarce. Pulmonary injury has been well documented with chronic salicylate toxicity. Animal lung biopsy studies of salicylate poisoning have demonstrated increased permeability of alveoli.[6] To the best of our knowledge, these findings have not been confirmed in humans other than at autopsy.[7] This case illustrates the magnitude of diffuse pulmonary damage resulting in respiratory failure from long-term salicylate use as well as histological evidence in an otherwise healthy individual.