A 72-year-old man was exposed to the
sarin gas attack in a Tokyo subway on March 20 th, 1995. After exposure, he noticed eye discomfort, chest tightness,
headache and weakness of the lower limbs and oropharyngeal muscles. Despite these symptoms, he visited a hot spring on the same day with his family. On March 25 th, his
muscle weakness progressed, and a low grade
fever appeared. His
muscle weakness disappeared 8 days after exposure to
sarin, but
respiratory failure rapidly developed, necessitating artificial ventilation within four day after hospitalization on March 28th.
Chemotherapy with
erythromycin,
imipenem/cilastatin, and
steroid pulse
therapy was begu. PCR and culture of sputum collected by bronchofiberscopy were positive for Legionella pneumophila, serogroup I. His respiratory state improved, but subsequent
infection with Pseudomonous aeruginosa. Enterobacter cloacae, and Candida tropicalis/glabrata caused his death 71 days after admission. Oropharyngeal
muscle weakness caused by
sarin-mediated
cholinesterase inhibition was strongly suspected as the cause of hot spring water aspiration. Transbronchial lung biopsy revealed
organizing pneumonia with
fibrosis. Bronchoscopic findings included redness,
edema and fragility of all visible areas of the airway, which was thought to be due to
bronchitis caused by
Legionellosis.