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We describe a series of unsuspected paraquat poisonings presenting as an outbreak of fatal acute pneumonitis. Exposure to paraquat occurred during the widespread practice of adding substances to alter the taste or potency of illicit alcohol. The diagnosis was suspected only after autopsy findings suggestive of paraquat toxicity were seen in the first fatality.An estimated 50 persons were exposed. Of these, 5 presented with ever and progressive dyspnoea, and died 9-30 days after exposure. We were able to trace 35 potentially exposed persons who survived, and compared them to the fatalities. Fever, headache, cough, dyspnoea, abdominal pain, hepatomegaly, and lung signs were more common among those who died. Autopsy revealed widespread renal and hepatic necrosis in the early deaths, and prominent pulmonary fibrosis in those dying later.This case series defines an unusual syndrome of paraquat poisoning, which should be considered in the diagnosis of outbreaks of acute pneumonitis in illicit alcohol users.