Inquest into the deaths of Sandra BONEY, Norman BONEY and Roger John ADAMS

Organising pneumonia (Sandra Boney and Norman Boney); Organising pneumonia complicating alcoholic liver disease (Roger Adams); all precipitated by methanol poisoning

Three Aboriginal Australians from Walli Reserve (Sandra Boney, 40; Norman Boney, 46; Roger Adams, 37) died within two months in early 2015 following consumption of illegally home-distilled methanol-containing alcohol ('moonshine'). All presented with atypical symptoms inconsistent with simple alcohol intoxication and were diagnosed initially as alcohol withdrawal. Clinical features included altered consciousness, tremors, vomiting, visual disturbances, and signs of methanol toxicity including acidosis. All subsequently developed organising pneumonia, likely secondary to methanol-induced immunosuppression. Early clinical recognition of methanol poisoning symptoms and alert recognition by health workers enabled police investigation and public health warnings. Clinical lessons: methanol toxicity should be suspected in atypical presentations in vulnerable populations with access to home-distilled alcohol; symptoms persist despite continued ethanol ingestion; and rapid escalation and inter-agency communication prevented further deaths.