Hydrocarbon pneumonitis following fuel siphonage: A case report and literature review

Gingiva squamous-cell carcinoma in a non-smoking patient with occupational exposure to solvent siphoning using mouth: case report and literature review

Background

While overall head and neck cancer incidence decreases due to reduced tobacco and alcohol consumption, the incidence of HPV negative oral cavity squamous cell carcinoma (SCC) is raising in several industrialized countries, especially in non-smoking and non-drinking patients.

Case presentation

We document a case of gingiva SCC in a 56 years old never-smoker patient reporting low alcohol consumption and unusual occupational solvent exposure. The HPV-negative lesion was surgically removed in 2018, and the patient remains in complete remission 4 years after recurrent surgery in 2019. In 2021, the patient was referred to the occupational cancer consultation. The patient worked as screen printer for 18 years. He reported mouth siphoning every 2-3 days to transfer organic solvents (mainly aromatic hydrocarbons and ketones) from containers into smaller recipients, with regular passage of solvents into his mouth.

Conclusion

According to the literature, the frequency of solvent siphoning using mouth is likely to be underestimated. While our review did not find studies reporting longterm consequences to the oral cavity of mouth siphoning, current evidence supports a positive association of upper aero digestive tract SCC with occupational exposures to organic solvents and printing processes. In absence of major extraprofessional factors, the HPV-negative gingiva SCC of this patient might be attributable to the regular occupational oral solvent exposure. While the available evidence remains limited to formally establish a causal relationship, clinicians should investigate this hazardous work practice in patients with OSCC and history of solvent exposures.

Hydrocarbon pneumonitis with abscess formation following diesel siphoning

A man in his early 40s presented with a 1-month history of fever after accidental diesel aspiration. He had received treatment with intravenous antibiotics, steroids and supportive care. Contrast-enhanced CT of the thorax revealed a right middle lobe lung abscess and bronchoscopy revealed hyperaemia around the middle lobe bronchus. The abscess was initially managed by drainage using a pigtail catheter and intravenous antibiotics. However, only partial drainage of the abscess was achieved and fever persisted. The cardiothoracic surgery team performed drainage of lung abscess through a right posterolateral thoracotomy. Postprocedure, the patient's symptoms improved and the patient was discharged in good health. This case demonstrates a rare complication of hydrocarbon aspiration pneumonitis and lung abscess. Post acute management of diesel aspiration, patients should be advised to return for medical assessment immediately, should symptoms like persistent fever and chest pain recur or persist as these symptoms may herald the development of post-hydrocarbon-aspiration lung abscess.

Report of a Rare Case of Computed Tomography Diagnosis of Hydrocarbon Pneumonitis

The practice of manually siphoning diesel from fuel tanks is widespread among car mechanics in Asian countries. To date, there are just a few reports in the literature about hydrocarbon pneumonitis caused by diesel fuel aspiration. An early diagnosis based on clinical suspicion, imaging results, and histopathology can help prevent permanent damage to the lungs.

A Multidrug Therapy for Hydrocarbon Aspiration With Acute Respiratory Distress Syndrome After Exposure to Oral Benzine Intake: A Case Report

Oral benzine intake with suicidal tendencies is an uncommon life-threatening respiratory emergency without a treatment regimen.

 A 50-year-old man attempted suicide with 100 ml of oral benzine intake and developed severe acute respiratory distress syndrome (ARDS) with hydrocarbon aspiration. He received mechanical ventilation with placement in the prone position and low tidal volume, neuromuscular blocking agents, bronchoalveolar lavage, steroid pulse therapy, antibiotics, and sivelestat sodium hydrate. He was transferred to the psychiatric hospital five days after admission without any adverse events.

ARDS associated with oral benzine intake could be treated with general treatments for ARDS.

The Hurricane Lung: A Case of Hydrocarbon Pneumonitis With Abscess Formation Following Fuel Siphoning

Fuel siphoning is a widespread practice worldwide, but infrequently observed in the United States. Some reports suggest greater incidence of fuel siphoning during the hurricane season. Fuel siphoning is associated with a high risk of hydrocarbon toxicity, often leading to the development of hydrocarbon pneumonitis. This form of exogenous lipoid pneumonia can present acutely with chest pain and dyspnea. While most cases of hydrocarbon pneumonitis resolve spontaneously with supportive care, rarely patients develop life-threatening complications. We present the case of a 56-year-old man who developed hydrocarbon pneumonitis complicated by abscess formation after attempting to siphon fuel from a gasoline tank in preparation for a hurricane.

Diesel siphoner's lung: An unusual cause of hydrocarbon pneumonitis

The practice of manual siphoning of diesel from fuel tanks is common among automobile mechanics in Nepal. When an automobile mechanic with a history of diesel siphonage presents with respiratory symptoms, the diesel siphoner's lung diagnosis should be considered. Clinical suspicion confirmed by radiological findings can help in early management and prevention of permanent damage.