High-dose corticosteroid application in acute severe nickel carbonyl poisoning: a case series of three occupational exposures and their recovery outcomes

Acute severe nickel carbonyl poisoning is an uncommon yet potentially fatal occupational hazard that produces marked pulmonary injury and rapidly progressive respiratory failure. We describe three middle-aged men who developed severe nickel carbonyl intoxication after workplace exposure at a metal-processing facility. All patients presented with progressive dyspnea, cyanosis, hypoxemia, and pronounced neutrophilia. Chest computed tomography revealed bilateral pulmonary infiltrates with variable early distribution across patients. Prompt recognition permitted immediate initiation of high-dose methylprednisolone, moxifloxacin, and individualized supportive care according to oxygen (O 2 ) requirements. All three patients exhibited striking clinical improvement within 72 h. Serial imaging suggested substantial resolution of pulmonary inflammation, and every patient recovered without residual impairment. Nickel carbonyl exposure demanded a high index of suspicion and prompt initiation of high-dose corticosteroid therapy was required to prevent irreversible lung injury and improve survival. This case series provides valuable clinical evidence to inform diagnostic and therapeutic approaches for this rare occupational poisoning.