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Wang JX, Wang BB, Chen HG, He SL, Yang RJ, Lei FF. [One case of severe exogenous lipoid pneumonia complicated with lung abscess caused by diesel inhalation]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2023; 41:695-699. [PMID: 37805433 DOI: 10.3760/cma.j.cn121094-20220420-00204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Exogenous lipoid pneumonia is an inflammatory response to the lungs caused by inhaled lipid substances, which is prone to secondary bacterial infection, resulting in the formation of local abscesses, which can be life-threatening in severe cases. This paper reports a case of a 55-year-old patient with diesel aspiration, secondary to Klebsiella pneumoniae (ESBL positive) and Candida glabrata infection resulting in lung abscess formation. He was treated with a variety of antibacterial drugs for anti-infection, non-invasive ventilator ventilation, bronchoalveolar lavage, glucocorticoids, phlegm and other medical treatments. Finally, he underwent middle lobectomy for improvement and was discharged from the hospital, and he recovered well with regular follow-up.
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Affiliation(s)
- J X Wang
- First Clinical Medical School, Gansu University of Chinese Medicine, Lanzhou 730000, China Department of Emergency, Gansu Provincial Hospital, Lanzhou 730000, China
| | - B B Wang
- Department of Emergency, Gansu Provincial Hospital, Lanzhou 730000, China
| | - H G Chen
- Department of Emergency, Gansu Provincial Hospital, Lanzhou 730000, China
| | - S L He
- The First Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou 730000, China
| | - R J Yang
- Department of Emergency, Gansu Provincial Hospital, Lanzhou 730000, China
| | - F F Lei
- Department of Respiratory and Critical Care Medicine, Gansu Provincial Hospital, Lanzhou 73000, China
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Uchida Y, Komatsu S, Tabata E, Okabayashi H, Niwa T, Okuda R, Baba T, Hagiwara E, Ogura T. A case of exogenous lipoid pneumonia diagnosed by transbronchial lung cryobiopsy. Respir Investig 2021; 59:555-558. [PMID: 33678587 DOI: 10.1016/j.resinv.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/10/2021] [Accepted: 02/03/2021] [Indexed: 11/24/2022]
Abstract
A 57-year-old man visited a referral physician due to abnormal chest shadows. Transbronchial lung biopsy (TBLB) failed to diagnose his condition. As antibiotics and systemic steroids did not improve the condition, he was referred to our hospital. A second TBLB in our hospital also failed to diagnose the disease. Transbronchial lung cryobiopsy (TBLC) was performed using radial endobronchial ultrasound with guide sheath (EBUS-GS), and the patient was diagnosed with lipoid pneumonia. Right upper lobe resection was performed, and lipoid pneumonia was confirmed from the surgical specimen. We report a case of lipoid pneumonia diagnosed by EBUS-GS TBLC.
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Affiliation(s)
- Yoshinori Uchida
- Kanagawa Cardiovascular and Respiratory Center, Department of Respiratory Medicine, Tomioka-Higashi 6-16-1, Kanazawa-ku, Yokohama, 236-0051, Japan; University of Yamanashi Hospital, Department of Internal Medicine 2, Shimokato 1110, Chuo-shi, Yamanashi, 409-3898, Japan.
| | - Shigeru Komatsu
- Kanagawa Cardiovascular and Respiratory Center, Department of Respiratory Medicine, Tomioka-Higashi 6-16-1, Kanazawa-ku, Yokohama, 236-0051, Japan
| | - Erina Tabata
- Kanagawa Cardiovascular and Respiratory Center, Department of Respiratory Medicine, Tomioka-Higashi 6-16-1, Kanazawa-ku, Yokohama, 236-0051, Japan
| | - Hiroko Okabayashi
- Kanagawa Cardiovascular and Respiratory Center, Department of Respiratory Medicine, Tomioka-Higashi 6-16-1, Kanazawa-ku, Yokohama, 236-0051, Japan
| | - Takashi Niwa
- Kanagawa Cardiovascular and Respiratory Center, Department of Respiratory Medicine, Tomioka-Higashi 6-16-1, Kanazawa-ku, Yokohama, 236-0051, Japan
| | - Ryo Okuda
- Kanagawa Cardiovascular and Respiratory Center, Department of Respiratory Medicine, Tomioka-Higashi 6-16-1, Kanazawa-ku, Yokohama, 236-0051, Japan
| | - Tomohisa Baba
- Kanagawa Cardiovascular and Respiratory Center, Department of Respiratory Medicine, Tomioka-Higashi 6-16-1, Kanazawa-ku, Yokohama, 236-0051, Japan
| | - Eri Hagiwara
- Kanagawa Cardiovascular and Respiratory Center, Department of Respiratory Medicine, Tomioka-Higashi 6-16-1, Kanazawa-ku, Yokohama, 236-0051, Japan
| | - Takashi Ogura
- Kanagawa Cardiovascular and Respiratory Center, Department of Respiratory Medicine, Tomioka-Higashi 6-16-1, Kanazawa-ku, Yokohama, 236-0051, Japan
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BOUTROS J, MUZZONE M, BENZAQUEN J, LEVRAUT M, MARQUETTE CH, ROCHER F, DIASCORN Y, PADOVANI B, HOFMAN V, LEROY S. A case report of exogenous lipoid pneumonia associated with avocado/soybean unsaponifiables. BMC Pulm Med 2019; 19:234. [PMID: 31795982 PMCID: PMC6892022 DOI: 10.1186/s12890-019-0997-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 11/14/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Exogenous lipoid pneumonia is a rare disease resulting from intra-alveolar accumulation of lipids of mineral, vegetal, or animal origin, that induce a foreign body type of inflammatory reaction in the lungs. Gastroesophageal reflux disease and other esophageal abnormalities have often been associated with this disease. CASE PRESENTATION We herein report the case of an 83-year-old patient in whom a follow-up chest computed tomography scan, for a lingular consolidation, showed multifocal ground glass and consolidative opacities with areas of low attenuation, suggestive of exogenous lipid pneumonia. The patient had been on piascledine capsules (avocado/soybean unsaponifiables) for 20 years and had a hiatal hernia with documented gastroesophageal reflux disease. After thorough history taking, no other predisposing factors were found. The diagnosis was confirmed using oil red staining of bronchoalveolar lavage showing lipid-laden macrophages and extracellular lipid droplets. CONCLUSIONS To our knowledge, this is the first case of ELP secondary to avocado/soybean unsaponifiables in the literature.
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Affiliation(s)
- Jacques BOUTROS
- Department of Pulmonary Medicine, Université Côte d’Azur, CHU de Nice, FHU OncoAge, 30 avenue de la voie Romaine, CS51069, 06001 Nice, France
| | - Marine MUZZONE
- Department of Pulmonary Medicine, Université Côte d’Azur, CHU de Nice, FHU OncoAge, 30 avenue de la voie Romaine, CS51069, 06001 Nice, France
| | - Jonathan BENZAQUEN
- Department of Pulmonary Medicine, Université Côte d’Azur, CHU de Nice, FHU OncoAge, 30 avenue de la voie Romaine, CS51069, 06001 Nice, France
- Université Côte d’Azur, CNRS UMR7284, Inserm U1081, Institute of Research on Cancer and Ageing (IRCAN), Nice, France
| | - Michael LEVRAUT
- Department of Pulmonary Medicine, Université Côte d’Azur, CHU de Nice, FHU OncoAge, 30 avenue de la voie Romaine, CS51069, 06001 Nice, France
| | - Charles-Hugo MARQUETTE
- Department of Pulmonary Medicine, Université Côte d’Azur, CHU de Nice, FHU OncoAge, 30 avenue de la voie Romaine, CS51069, 06001 Nice, France
- Université Côte d’Azur, CNRS UMR7284, Inserm U1081, Institute of Research on Cancer and Ageing (IRCAN), Nice, France
| | - Fanny ROCHER
- Université Côte d’Azur, CHU de Nice, Regional Pharmacovigilance Center, Nice, France
| | - Yann DIASCORN
- Department of Radiology, Université Côte d’Azur, CHU de Nice, Nice, France
| | - Bernard PADOVANI
- Department of Radiology, Université Côte d’Azur, CHU de Nice, Nice, France
| | - Véronique HOFMAN
- Laboratory of Clinical and Experimental Pathology, Université Côte d’Azur, CHU de Nice, FHU OncoAge, Nice, France
| | - Sylvie LEROY
- Department of Pulmonary Medicine, Université Côte d’Azur, CHU de Nice, FHU OncoAge, 30 avenue de la voie Romaine, CS51069, 06001 Nice, France
- Université Côte d’Azur, CNRS UMR 7275 - Institut de Pharmacologie Moléculaire et Cellulaire, Sophia Antipolis, France
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Abstract
Exogenous lipoid pneumonia is a rare alveolar-filling disorder characterized by foreign body reaction to inhaled/aspirated hydrocarbon that may be vegetable oil, animal fat, or mineral oil. It is vanishingly rare and often missed except in the classical clinical settings of acute aspiration of petroleum products. We present a toddler with iatrogenic exogenous lipoid pneumonia and highlight clinical and radiological clues that can prompt early recognition of this entity.
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Affiliation(s)
- S Rajagopala
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - N Selvam
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Wang YX, Fang F, Guo YF, Li YM, Sun TY, Zhang M, Chen J, Fang BM. [Analysis of 12 cases of exogenous lipoid pneumonia confirmed by pathology]. Zhonghua Jie He He Hu Xi Za Zhi 2017; 40:445-449. [PMID: 28592028 DOI: 10.3760/cma.j.issn.1001-0939.2017.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To study the etiological, clinical, radiological, diagnostic, therapeutic, and prognostic manifestations of exogenous lipoid pneumonia (ELP), and therefore to improve the diagnosis and treatment of this disease. Methods: The clinical data of 12 cases of ELP confirmed by pathology were retrospectively analyzed. Results: The patients consisted of 9 males and 3 females, with an average age of 73.8 years (range, 44 to 100 years). The underlying diseases were variable, including diseases affecting the general condition (multiple organ failure, chronic heart and renal insufficiency, pemphigoid, etc) and conditions with increased risk of aspiration (sequelae of cerebrovascular disease, Alzheimer's disease, advanced stage of nasopharyngeal carcinoma, paralytic ileus, etc). The 12 cases were all caused by Inhalation of mineral oil. Common symptoms included cough, sputum production and dyspnea. ELP had no special physical signs. Inflammation indexes, such as white blood cell, neutrophil percentage, ESR, C reactive protein, procalcitonin, D-Dimer, and blood lipid levels were usually normal. Radiological features of ELP mainly included consolidation, mass or nodules, with a little ground-glass opacity. Some patients had ventilation and/or diffusion dysfunction. The diagnostic methods included CT-guided percutaneous lung biopsy, thoracoscopy, thoracotomy or autopsy. Histopathological findings showed accumulation of large foamy macrophages in the alveolar spaces, with a few lipid deposition and polykaryocytes. The main treatment of ELP was cessation of lipid material contact. One case died of ELP, 6 died of other coexisting diseases, and the rest 6 improved with treatment and were discharged. The survival patients were all stable during a follow-up of 2-4.5 years. Conclusions: ELP was rare and its clinical manifestation was atypical. Its radiological manifestations were indistinguishable from pneumonia, lung cancer, interstitial lung diseases, etc. Pathological examination was the gold standard for diagnosis, and the preferred means of sampling was bronchoscopy. In cases whose diagnosis could not be confirmed by BALF, CT-guided percutaneous lung biopsy might be considered. The most important treatment is cessation of lipid material contact. The prognosis is good.
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Affiliation(s)
- Y X Wang
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
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Kilaru H, Prasad S, Radha S, Nallagonda R, Kilaru SC, Nandury EC. Nasal application of petrolatum ointment - A silent cause of exogenous lipoid pneumonia: Successfully treated with prednisolone. Respir Med Case Rep 2017; 22:98-100. [PMID: 28736697 DOI: 10.1016/j.rmcr.2017.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/02/2017] [Accepted: 07/05/2017] [Indexed: 01/15/2023] Open
Abstract
We report a case of exogenous lipoid pneumonia from chronic, extranasal use of petrolatum ointment (Vicks VapoRub in this case) for nasal decongestion in a young woman, presenting with cough, dyspnea and fever. Exogenous Lipoid pneumonia is a rare condition, underdiagnosed and is more prevalent in adults. Usually asymptomatic and diagnosed while evaluating predisposed patients who become clinically unstable or an abnormal lung shadow or during evaluation of rhinobronchial allergy. It is rarely reported from chronic use of petrolatum ointment extranasally and was diagnosed by transbronchial biopsy in the present case. She was found, retrospectively, to have been using petrolatum ointment, as an extranasal application since more than a year at bedtime. She didn't give history of using any other oil-based nasal topical vasoconstrictor preparations for sinusitis. Our patient was managed with discontinuation of further use of the petrolatum ointment and treatment with prednisolone apart from her regular treatment for chronic rhinobronchial allergy. Patient is stable without any further radiological deterioration during follow-up of one year.
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Katsumi H, Tominaga M, Tajiri M, Shimizu S, Sakazaki Y, Kinoshita T, Okamoto M, Kawayama T, Hoshino T. A case of lipoid pneumonia caused by inhalation of vaporized paraffin from burning candles. Respir Med Case Rep 2016; 19:166-168. [PMID: 27766199 PMCID: PMC5065644 DOI: 10.1016/j.rmcr.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 09/30/2016] [Accepted: 10/03/2016] [Indexed: 01/15/2023] Open
Abstract
A 66-year-old woman was referred to our hospital for investigation of interstitial lung disease. She had spent most of her time in a shrine, and had always been exposed to vaporized paraffin from burning candles. Chest High-resolution computed tomography (HRCT)showed ground-glass attenuation with thickening of septal lines, wh create the so-called "crazy-paving appearance". Although bronchoalveolar lavage(BAL) and transbronchial biopsy were performed to aid in diagnosis, the findings did not reveal any conclusive information. Improvements on chest radiographs and in the patient's symptoms were observed without any therapeutic intervention; however, one year later, her chest X-ray showed deteriorative changes. Surgical lung biopsy was performed, and the pathological findings were consistent with those of lipoid pneumonia. The patient showed spontaneous remission of the disease. The cause of exogenous lipoid pneumonia was attributed to inhalation of vaporized paraffin from burning candles in the shrine. This is the first case of lipoid pneumonia that was found to develop from exposure to vaporized paraffin.
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Cherrez Ojeda I, Calderon JC, Guevara J, Cabrera D, Calero E, Cherrez A. Exogenous lipid pneumonia related to long-term use of Vicks VapoRub® by an adult patient: a case report. BMC Ear Nose Throat Disord 2016; 16:11. [PMID: 27547123 PMCID: PMC4992226 DOI: 10.1186/s12901-016-0032-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/09/2016] [Indexed: 01/15/2023]
Abstract
Background Use of petroleum-based over the counter remedies such as Vicks VapoRub to alleviate symptoms of rhinitis is common and can be effective, but carries under-appreciated risks of adverse side effects. In this case report we highlight Exogenous Lipoid Pneumonia (ELP), an uncommon condition that results from accumulation of exogenous lipids in the alveoli, as an adverse side effect of long-term Vicks VapoRub use. Case presentation We present the case of an 85-year-old female patient with ELP apparently due to continuous application of Vicks VapoRub® to her nostrils to alleviate chronic rhinitis. She was diagnosed incidentally via chest radiograph and computed tomography (CT) scan done as follow up to finding elevated C-reactive Protein during a routine exam. The CT scan revealed a pulmonary consolidation in the lower lobe of the right lung with fat density combined with low density areas associated with focal ground-glass opacities. The patient was advised to discontinue use of petroleum-based products, and was prescribed intranasal corticosteroids for her rhinitis. Follow up 2 years later showed that the lipid consolidation had diminished in size by approximately 10 %. Conclusion Physicians must be aware that ELP can develop as a result of long-term application of petroleum-based oils and ointments to the nose and discourage such use of these products. Patients who have used petroleum-based products in this way should be screened for ELP. CT scan is the best imaging modality for establishing the diagnosis. The treatment of this condition is not well defined, but, as shown in this case, the size of the lipid mass can decrease after use of petroleum based substances is discontinued. Electronic supplementary material The online version of this article (doi:10.1186/s12901-016-0032-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- I Cherrez Ojeda
- Universidad de Especialidades Espiritu Santo, School of Medicine, Samborondón, Guayas, 09150 Guayaquil, Ecuador ; Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - J C Calderon
- Universidad de Especialidades Espiritu Santo, School of Medicine, Samborondón, Guayas, 09150 Guayaquil, Ecuador ; Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | | | - D Cabrera
- Universidad de Especialidades Espiritu Santo, School of Medicine, Samborondón, Guayas, 09150 Guayaquil, Ecuador ; Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - E Calero
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - A Cherrez
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador ; University of Heidelberg, School of Medicine, Heidelberg, Germany
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Doubková M, Doubek M, Moulis M, Skřičková J. Exogenous lipoid pneumonia caused by chronic improper use of baby body oil in adult patient. Rev Port Pneumol 2013; 19:233-6. [PMID: 23830509 DOI: 10.1016/j.rppneu.2013.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 04/10/2013] [Accepted: 05/11/2013] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Exogenous lipoid pneumonia (ELP) is an uncommon condition resulting from aspirating or inhaling fatlike material. These substances elicit a foreign body reaction and proliferative fibrosis in the lung. CASE REPORT We report a case of a 38-year-old woman with bilateral pulmonary infiltration. There were no clinical symptoms of this infiltration at diagnosis. The infiltration was found coincidentally during the pre-operation examination before surgery. A chest computed tomography scan revealed bilateral lung consolidation, particularly in the S6 area on the right side. The transthoracic lung biopsy led to suspicion of ELP. Precise anamnesis confirms the diagnosis of ELP caused by chronic improper use of baby body oil. Two years after discontinuing "baby body oil therapy", a chest CT scan revealed partial regression of pulmonary infiltration. CONCLUSION The diagnosis of exogenous lipoid pneumonia is often difficult as symptoms, signs, and radiographic findings are all rather non-specific. We would like to emphasize the role of precise case history in better identification of ELP.
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Affiliation(s)
- M Doubková
- Department of Pneumology and Phthiseology, Faculty of Medicine and University Hospital, Brno, Czech Republic.
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