Delayed Respiratory Failure After Sulfuric Acid Mist Inhalation From a Foaming Lead-Acid Battery.

Background: Sulfuric acid inhalation can cause respiratory tract injury and life-threatening respiratory failure. Reports of delayed hypoxemia after exposure to acid aerosols generated from foaming lead-acid batteries are rare. Case Presentation: An 80-year-old auto mechanic inhaled an odorless aerosol for seconds while leaning over a foaming lead-acid battery in an enclosed garage, and presented with dyspnea and type I respiratory failure (PaO2/FiO2 ratio = 195) after 13 days. Chest computed tomography showed bilateral ground-glass opacities with superimposed right lung consolidation. Microbiological tests and autoantibody panel results were negative. High-flow nasal cannula oxygen and intravenous systemic corticosteroids were initiated, with rapid improvement. Antibiotics were discontinued on day 8 and corticosteroids were tapered over 40 days followed by the patient's discharge on day 43. Conclusion: Sulfuric acid inhalation can follow a subacute and progressive course. In severe cases, multimodal supportive care and selective systemic corticosteroids may be considered post-assessment.