Acute exogenous lipoid pneumonia caused by accidental kerosene ingestion in an elderly patient with dementia: A case report

A severe case of acute exogenous lipoid pneumonia treated with systemic corticosteroid

Acute exogenous lipoid pneumonia is a rare disorder in adults. A treatment of choice for lipoid pneumonia has not been established, and systemic corticosteroid use remains controversial. We report the case of a 32-year-old man with schizophrenia who presented with kerosene-induced acute exogenous lipoid pneumonia that was treated with a systemic corticosteroid. In this case, supportive therapy did not improve the patient's condition, so systemic corticosteroid therapy was commenced four days after he ingested the kerosene. After corticosteroid commencement, the patient's symptoms and hypoxia improved within a few days. Although some radiological characteristics of this disorder have been reported previously, the process of radiological improvement of exogenous lipoid pneumonia is not well known. In this case, computed tomography findings changed dramatically after corticosteroid therapy was initiated. Extensive bilateral consolidations that were observed on admission improved. Although pneumatoceles developed two weeks after corticosteroid commencement, they were nearly gone after two months of the treatment. While corticosteroid therapy is not suitable for all cases, it should be considered for severe or refractory cases.

Exogenous lipoid pneumonia caused by repeated sesame oil pulling: a report of two cases

BACKGROUND

Exogenous lipoid pneumonia is a rare disease caused by aspiration or inhalation of oily substances.

CASE PRESENTATION

A 66-year-old male with dry cough (Case 1) and a 38-year-old female with shortness of breath (Case 2) demonstrated ground-glass opacities on chest computed tomography and were diagnosed with lipoid pneumonia based on the confirmation of lipid-laden alveolar macrophages. Both patients habitually performed sesame oil pulling via nasal or mouth washing for several months prior to the diagnosis.

CONCLUSION

Steroid therapy and bronchoalveolar lavage resulted in improvement in Case 1, and no intensive therapy was required for Case 2. Sesame oil pulling has been rarely been reported to cause lipoid pneumonia.

Effects and mechanisms of kerosene use-related toxicity

Kerosene is a heterogeneous hydrocarbon substance that continues to find many uses worldwide due to its economic viability and ease of availability. In spite of kerosene's many uses, it is known to cause harm to various body organs and systems. Major affected body organs/systems are the pulmonary system, central nervous system, cardiovascular system, the skin, immune system and liver. This review discusses the various kerosene-mediated adverse health effects and possible mechanisms by which kerosene is likely to inflict such effects. These mechanisms are quite varied and include induction of inflammation, loss of effectiveness of pulmonary surfactants, hypoxia, production of highly reactive oxidative metabolites, extraction of endogenous epidermal and membrane lipids, necrosis, hormonal and enzymatic levels changes, and immunosuppression. Understanding of the above will allow for proper relevant policy formulation and targeted kerosene-mediated morbidity and mortality preventive and management initiatives.