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Wang H, Lu S, Li H, Wang Y. Mycobacterium infection secondary to exogenous lipoid pneumonia caused by nasal drops: a case report and literature review. BMC Pulm Med 2023; 23:47. [PMID: 36721116 PMCID: PMC9887914 DOI: 10.1186/s12890-022-02265-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/24/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Exogenous lipoid pneumonia (ELP) is a rare disease and its diagnosis is often mistaken or delayed. Secondary infection with rapidly growing non-tuberculous mycobacteria is a rare complication of lipoid pneumonia. CASE PRESENTATION A 38-year-old man presented with fever, cough, sputum, chest tightness, and shortness of breath. He had a 2-year history of allergic rhinitis and used liquid paraffin-containing menthol nasal drops daily. A chest CT scan showed multiple patchy ground glass opacities with blurred borders in both lungs, which were located in the inner pulmonary field and distributed along the bronchi. His ambient air PO2 was 63 mmHg. The patient was diagnosed with ELP by CT-guided lung biopsy. The nasal drops were discontinued, and systemic glucocorticoids were administered. During treatment, the pulmonary lesions deteriorated, and bronchoalveolar lavage was performed during bronchoscopy. Additionally, Mycobacterium abscessus was detected in the lavage fluid. Upon detection of a secondary M. abscessus infection, glucocorticoids were gradually discontinued, and anti-M. abscessus treatment was implemented. The patient's symptoms rapidly ameliorated. After 11 months of anti-M. abscessus treatment, a repeat CT scan showed clear regression of the lung lesions. CONCLUSION Routine microbiological examination of samples, including sputum or alveolar lavage fluid, is necessary for patients with diagnosed or suspected ELP.
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Affiliation(s)
- Huihong Wang
- grid.13402.340000 0004 1759 700XDepartment of Respiratory Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 China ,grid.469636.8Department of Respiratory Diseases, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000 Zhejiang Province China
| | - Shan Lu
- grid.13402.340000 0004 1759 700XDepartment of Respiratory Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 China
| | - Hequan Li
- grid.13402.340000 0004 1759 700XDepartment of Respiratory Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 China
| | - Yuehong Wang
- grid.13402.340000 0004 1759 700XDepartment of Respiratory Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 China
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AlShamrani AS, Alzaid MA, Fadl SM, AlFaki MA. A case of infantile exogenous lipoid pneumonia with an unusual complication managed by modified whole lung lavage. Sudan J Paediatr 2021; 21:82-88. [PMID: 33879948 DOI: 10.24911/sjp.106-1587896995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Exogenous lipoid pneumonia (ELP) is a known complication of lipid administration through either the nasal or oral route. ELP in paediatric patients is usually managed by discontinuing lipid administration and supportive care, including respiratory support and the use of antibiotics for secondary bacterial infection. The other modalities that remain controversial include the use of corticosteroids and clearing lipids by whole lung lavage. We report a 2-month-old infant who presented with pneumonia and whose further history revealed exposure to ghee over a month period while visiting her grandparents in the south region of Saudi Arabia. The patient was later diagnosed as having ELP and was successfully managed with modified whole lung lavage till weaned off from oxygen. Unfortunately, the case was complicated by nontuberculous Mycobacterium chelonae, and the patient died despite maximum intervention.
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Affiliation(s)
- Abdullah Saeed AlShamrani
- Pediatric Pulmonary Section, Pediatric Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed Abdullah Alzaid
- Pediatric Pulmonary Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sarrah M Fadl
- Pediatric Pulmonary Section, Pediatric Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed Ahmed AlFaki
- Pediatric Pulmonary Section, Pediatric Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Jeelani HM, Sheikh MM, Sheikh B, Mahboob H, Bharat A. Exogenous Lipoid Pneumonia Complicated by Mineral Oil Aspiration in a Patient With Chronic Constipation: A Case Report and Review. Cureus 2020; 12:e9294. [PMID: 32832291 PMCID: PMC7437133 DOI: 10.7759/cureus.9294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Exogenous lipoid pneumonia is a rare and frequently misdiagnosed lung disease. It occurs as an inflammatory reaction secondary to either aspiration or inhalation of lipids. Our patient had a history significant for recurrent pneumonia and the use of mineral oil for chronic constipation. A chest computed tomography showed multifocal consolidative opacities with areas of low attenuation, highly suspicious of exogenous lipid pneumonia. The diagnosis was confirmed with combined bronchoalveolar lavage and transbronchial lung biopsy that showed lipid-laden macrophages consistent with exogenous lipoid pneumonia. After thorough medication review, apart from mineral oil, no other contributing factors were found. A diagnosis of exogenous lipoid pneumonia associated with the use of mineral oil made and successfully managed by stopping the offending agent and supportive antibiotics.
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Affiliation(s)
| | | | - Belaal Sheikh
- Internal Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, USA.,Internal Medicine, Chicago Medical School, North Chicago, USA
| | - Hafiz Mahboob
- Pulmonary and Critical Care Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
| | - Anchit Bharat
- Internal Medicine, Indiana University Health Ball Memorial Hospital, Muncie, USA
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Marangu D, Gray D, Vanker A, Zampoli M. Exogenous lipoid pneumonia in children: A systematic review. Paediatr Respir Rev 2020; 33:45-51. [PMID: 30962152 PMCID: PMC7106224 DOI: 10.1016/j.prrv.2019.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/08/2018] [Accepted: 01/16/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To describe the clinical-radiological-pathological characteristics and treatment outcomes of children with suspected exogenous lipoid pneumonia (ELP). DESIGN Systematic review. We searched electronic databases and reference lists published between 1967 and 2018, restricted to non-accidental cases. RESULTS Forty-four studies including 489 participants aged 1 day to 17 years from 13 countries were included. Cultural, medical, and behavioural rationale for oil-use was described. The clinical-radiological presentation varied widely. Diagnostic certainty was deemed highest if ELP was confirmed on bronchoalveolar lavage/frozen section lung biopsy with documented extracellular lipid on cytological staining and/or fat analysis. Non-tuberculous mycobacteria infection was identified in six studies: Mycobacterium fortuitum/chelonei, Mycobacterium smegmatis and Mycobacterium abscessus. Treatment comprised supportive therapy, corticosteroids, stopping oil, therapeutic lung-lavage and surgical resection. Outcomes were reported inconsistently. CONCLUSION Paediatric ELP resulting from cultural and medical practices continues to be described globally. Preventive interventions, standardized reporting, and treatment efficacy studies for cases not averted, are lacking. Protocol registration: PROSPERO CRD42017068313.
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Affiliation(s)
- Diana Marangu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya; Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
| | - Diane Gray
- Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Aneesa Vanker
- Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Marco Zampoli
- Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Goussard P, Rabie H, Morrison J, Schubert PT. Superinfection with Mycobacteria goodii in a young infant with exogenous lipoid pneumonia. Pediatr Pulmonol 2019; 54:1345-1347. [PMID: 31206238 DOI: 10.1002/ppul.24355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/17/2019] [Accepted: 04/24/2019] [Indexed: 11/11/2022]
Affiliation(s)
- P Goussard
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa
| | - H Rabie
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa
| | - J Morrison
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa
| | - P T Schubert
- Department of Pathology, Division of Anatomical Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa
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Alvarado A, Arce I. Metabolic Functions of the Lung, Disorders and Associated Pathologies. J Clin Med Res 2016; 8:689-700. [PMID: 27635172 PMCID: PMC5012236 DOI: 10.14740/jocmr2668w] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2016] [Indexed: 01/04/2023] Open
Abstract
The primary function of the lungs is gas exchange. Approximately 400 million years ago, the Earth's atmosphere gained enough oxygen in the gas phase for the animals that emerged from the sea to breathe air. The first lungs were merely primitive air sacs with a few vessels in the walls that served as accessory organs of gas exchange to supplement the gills. Eons later, as animals grew accustomed to a solely terrestrial life, the lungs became highly compartmentalized to provide the vast air-blood surface necessary for O2 uptake and CO2 elimination, and a respiratory control system was developed to regulate breathing in accordance with metabolic demands and other needs. With the evolution and phylogenetic development, lungs were taking a variety of other specialized functions to maintain homeostasis, which we will call the non-respiratory functions of the lung and that often, and by mistake, are believed to have little or no connection with the replacement gas. In this review, we focus on the metabolic functions of the lung, perhaps the least known, and mainly, in the lipid metabolism and blood-adult lung vascular endothelium interaction. When these functions are altered, respiratory disorders or diseases appear, which are discussed concisely, emphasizing how they impact the most important function of the lungs: external respiration.
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Affiliation(s)
- Alcibey Alvarado
- Internal Medicine and Neumology, Clinica de Diagnostico Medico, San Jose, Costa Rica
| | - Isabel Arce
- Medicine and General Surgery, Medicine School, University of Costa Rica, San Jose, Costa Rica
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Exogenous lipoid pneumonia. Clinical and radiological manifestations. Respir Med 2011; 105:659-66. [DOI: 10.1016/j.rmed.2010.12.001] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 11/28/2010] [Accepted: 12/01/2010] [Indexed: 11/23/2022]
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Affiliation(s)
- Dolly Sharma
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
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[Lung diseases and gastro-oesophageal reflux disease]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2009; 15:899-921. [PMID: 19649547 DOI: 10.1016/s0873-2159(15)30185-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Gastro -oesophageal Reflux Disease is a consequence of pathological reflux from stomach to oesophagus. Whenever the refluxed contents extended beyond the oesophagus itself, is called Extraoesophageal Reflux Disease. The author proposes a review about pulmonary disorders and gastroesophageal reflux. Previously, it is evaluated in an abridged way, the concepts of each diseases and after that, in a systematic form, it is discussed the prevalence of gastro -oesophageal reflux in lung diseases, all the mechanisms studies and the impact of gastro -oesophageal treatment on lung disorders. The author concludes that is undeniable the link between Gastro -oesophageal reflux and lung diseases and further reaserch is mandatory in order to corroborate this association.
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Boutou AK, Trigonis I, Pigadas A, Argyropoulou P, Stanopoulos I. Exogenous Lipoid Pneumonia Complicated with Mycobacterium Infection in a Subject with Zenker Diverticulum. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v38n2p177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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