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Siebert K, Jassem E, Porzezińska M, Jelitto M, Bernard W. Lipoid pneumonia induced by aspiration of liquid paraffin. Ann Agric Environ Med 2024; 31:144-146. [PMID: 38549489 DOI: 10.26444/aaem/168783] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
INTRODUCTION This case report describes a case of exogenous lipoid pneumonia (ELP) resulting from the inhalation of a lipoid substance. Lipoid pneumonia, also known as cholesterol pneumonia or golden pneumonia, is an uncommon inflammatory lung disease characterized by the presence of lipid-laden macrophages in the alveolar walls and lung interstitial tissue. Exogenous lipoid pneumonia occurs when substances containing lipids enter the airways through aspiration or inhalation, triggering an inflammatory response. CASE REPORT The patient in this case study was an 83-year-old woman with hypertension and diabetes mellitus who had been using paraffin oil as a mouthwash for an extended period. The diagnosis of exogenous lipoid pneumonia was established based on the patient's history of exposure to liquid paraffin oil, typical radiological findings, and histopathological examination.
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Affiliation(s)
- Konrad Siebert
- Department of Pneumonology and Allergology, University Clinical Centre, Medical University, Gdańsk, Poland
| | - Ewa Jassem
- Department of Pneumonology and Allergology, University Clinical Centre, Medical University, Gdańsk, Poland
| | - Maria Porzezińska
- Department of Pneumonology and Allergology, University Clinical Centre, Medical University, Gdańsk, Poland
| | - Małgorzata Jelitto
- Second Department of Radiology, Clinical Centre, Medical University, Gdańsk, Poland
| | - Weronika Bernard
- Second Department of Radiology, Clinical Centre, Medical University, Gdańsk, Poland
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2
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Murphy RJ, Tessier S, Longo S, Alia CS, Ido F. Extrinsic lipoid pneumonia due to chronic polyethylene glycol consumption: A case report. Respir Investig 2023; 61:768-772. [PMID: 37716285 DOI: 10.1016/j.resinv.2023.08.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 07/24/2023] [Accepted: 08/03/2023] [Indexed: 09/18/2023]
Abstract
Extrinsic lipoid pneumonia (ELP) results from the aspiration of lipid-containing substances. Tissue or cell histopathology after Oil-Red-O staining can confirm the diagnosis, which requires proper tissue handling and preparation during bronchoscopy. Here, we report a case of ELP in a quadriplegic patient with a long history of dysphagia and polyethylene glycol consumption. Computed tomography (CT) of the chest revealed multiple, progressively enlarging, fat-attenuated, nodular pulmonary lesions. Bronchoscopy with bronchoalveolar lavage (BAL) and a transbronchial forceps biopsy confirmed the diagnosis of lipoid pneumonia. We discuss the clinical, radiological, and pathological features of ELP and highlight the preparatory steps required for obtaining a successful diagnosis.
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Affiliation(s)
- Robert J Murphy
- Lewis Katz School of Medicine, Temple University, 3500 N. Broad Street, Suite 124, Philadelphia, PA 19140, USA
| | - Steven Tessier
- Lewis Katz School of Medicine, Temple University, 3500 N. Broad Street, Suite 124, Philadelphia, PA 19140, USA
| | - Santo Longo
- Department of Pathology, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA
| | - Christopher S Alia
- Department of Pulmonology and Critical Care, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA
| | - Firas Ido
- Department of Pulmonology and Critical Care, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Acharya V, Dsouza NV, Sreeram S, Rai SPV, Achappa B. Shine like gold and sparkle like glitter: Three cases of lipoid pneumonia. Respir Med Case Rep 2021; 33:101380. [PMID: 33777689 PMCID: PMC7985690 DOI: 10.1016/j.rmcr.2021.101380] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/20/2021] [Accepted: 03/03/2021] [Indexed: 11/25/2022] Open
Abstract
Lipoid pneumonia (LP) is an unwonted, mostly asymptomatic entity which has no classical radiological appearance. It can be endogenous or exogenous depending upon the type of exposure or underlying milieu. It simulates a number of infective and malignant respiratory conditions and can go undiagnosed or delayed leading to morbidity and mortality. We put forward three cases that initially presented as classical pneumonia, but on further assessment and investigations were diagnosed to be LP. All the three cases manifested with symptoms of fever, productive cough and breathlessness. Chest Xray and CT scan were indicative of consolidation. Bronchoalveolar lavage (BAL) evinced lipid laden macrophages that stained positive with fat stains (Sudan IV and Oil Red O). Two cases were endogenous and one was exogenous type. LP, owing to its nonspecific clinical presentation and radiographic signs, needs a high index of suspicion, and a detailed clinical history for accurate diagnosis. Corroboration of lipid laden alveolar macrophages in BAL is the crux to the diagnosis. Hence, clinicians should be cognizant of this condition and rule out LP in cases of non-resolving pneumonia in an appropriate clinical context.
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Affiliation(s)
- Vishak Acharya
- Department of Pulmonary Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Nikhil Victor Dsouza
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Saraswathy Sreeram
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Santosh P V Rai
- Department of Radiodiagnosis, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Basavaprabhu Achappa
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Nakagawara K, Sasaki M, Morinaga S, Minematsu N. Pattern of FDG-PET uptake in lipoid pneumonia simulating lung cancer. Respir Med Case Rep 2020; 31:101255. [PMID: 33101898 DOI: 10.1016/j.rmcr.2020.101255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/07/2020] [Accepted: 10/07/2020] [Indexed: 11/12/2022] Open
Abstract
Lipoid pneumonia presents with a variety of lung abnormalities, particularly mass forming lesions that mimic lung cancers. While 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) is expected to discriminate both diseases, some previous reports showed pseudo-positive FDG uptake in lipoid pneumonia. Here, we report a case of pathologically proven chronic lipoid pneumonia in a 78-year-old Japanese man. Computed tomography (CT) showed multi-lobar mass-forming lesions with a fat-density. PET confirmed the spotty accumulation of FDG in the corresponding fat-density area on CT, suggesting lipoid pneumonia. We reviewed the literature and discussed the FDG uptake patterns in lipoid pneumonia.
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Williams V, Ezhumalai G, Thakur A, Bansal A, Jayashree M. Acute exogenous lipoid pneumonia presenting as spontaneous air leak following accidental baby oil aspiration. Trop Doct 2019; 50:149-152. [PMID: 31876246 DOI: 10.1177/0049475519896206] [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] [Indexed: 11/16/2022]
Abstract
Exogenous lipoid pneumonia (ELP) is an uncommon cause of respiratory distress. The practice of oil massage and oil instillation into the nostrils is common in the Indian subcontinent. Accidental aspiration of baby oil may lead to significant chemical pneumonitis. This presentation may vary from subtle to severe respiratory distress requiring intensive care management. Spontaneous air leaks are rare in acute ELP. We successfully managed a six-month-old girl presenting with mineral oil-induced ELP and air leaks. However, these children require long-term follow-up, as a small proportion may evolve into chronic lung disease.
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Affiliation(s)
- Vijai Williams
- DM, Senior Resident, Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Gopalakrishnan Ezhumalai
- MD, Senior Resident, Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ajay Thakur
- MD, Senior Resident, Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun Bansal
- MD, FCCM, FRCPCH, Professor, Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Muralidharan Jayashree
- MD, Professor, Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Dicpinigaitis PV, Trachuk P, Fakier F, Teka M, Suhrland MJ. Vaping-Associated Acute Respiratory Failure Due to Acute Lipoid Pneumonia. Lung 2020; 198:31-3. [PMID: 31583455 DOI: 10.1007/s00408-019-00277-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
Electronic cigarettes, pens, cartridges and other devices were developed as nicotine delivery systems not requiring combustion of tobacco leaves. This technology was subsequently employed to deliver the cannabis component tetrahydrocannabinol (THC) via products often manufactured without adequate quality oversight and sold illegally. Recently, five patients presenting within a 2-month period with acute respiratory failure due to acute lipoid pneumonia after inhaling THC-containing concentrates or oils have been described. We report a 28-year-old previously healthy man who presented in acute respiratory failure 2 weeks after initiating use of a street-purchased THC-containing vape cartridge. Bronchoalveolar lavage cytology with oil red O staining confirmed the diagnosis of acute lipoid pneumonia. Diffuse alveolar hemorrhage and eosinophilic pneumonia were excluded. Evolving evidence supports a clinical entity of acute respiratory failure due to acute, exogenous lipoid pneumonia induced by THC-containing concentrates or oils inhaled through a variety of vaping products. All six patients reported to date received intravenous corticosteroids and survived to hospital discharge.
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Tancredi A, Graziano P, Scaramuzzi R, Scaramuzzi G, Carosi I, Attino V, Cuttitta A, Taurchini M. Exogenous Lipoid Pneumonia due to Chronic Inhalation of Oily Product Used as a Lubricant of Tracheotomy Cannula. Eurasian J Med 2018; 50:125-127. [PMID: 30002581 DOI: 10.5152/eurasianjmed.2018.17325] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/03/2018] [Indexed: 11/22/2022] Open
Abstract
Exogenous lipoid pneumonia (ELP) is caused by the inhalation of vaporized oily products. Long-term exposure can result in chronic disease, whereas acute form usually results from massive aspiration of fatty substances. It has an incidence of 1.0%-2.5%. In case of symptomatic patients, the clinical presentation mainly includes acute or chronic respiratory symptoms such as dyspnea, fever, cough and less frequently chest pain, hemoptysis, or weight loss. Radiological findings are often aspecific or misinterpreted, and ELP is sometimes misdiagnosed as a malignancy of the lungs. Patient history and radiological findings can lead to a suspicion of ELP, but histological microscopic findings of intra-alveolar lipid and lipid-laden macrophages are required to confirm the diagnosis The mainstay of treatment consists of avoiding ongoing exposure and providing supportive care as repeated whole-lung lavage, corticosteroids, and/or immunoglobulins. Surgery is reserved for cases of high suspicion of cancer or serious clinical impact (as recurrent infections). Prognosis is benign, even if it has been reported cases of progression to severe respiratory failure, cor pulmonale, superinfection, and association with lung cancer. Here, we describe a case of ELP due to chronic inhalation of oily product (Vaseline) used as a lubricant of tracheotomy cannula.
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Affiliation(s)
- Antonio Tancredi
- Unit of General Surgery 2nd and Thoracic Surgery, IRCCS " Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Foggia, Italy.,Department of Emergency Medicine, IRCCS " Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Foggia, Italy
| | - Paolo Graziano
- Unit of Pathology, IRCCS " Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Foggia, Italy
| | - Roberto Scaramuzzi
- Unit of General Surgery 2nd and Thoracic Surgery, IRCCS " Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Foggia, Italy.,Unit of Thoracic Surgery, Second University of Naples, Naples, NA, Italy
| | - Gerardo Scaramuzzi
- Unit of General Surgery 2nd and Thoracic Surgery, IRCCS " Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Foggia, Italy
| | - Illuminato Carosi
- Unit of Pathology, IRCCS " Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Foggia, Italy
| | - Vito Attino
- Unit of Pathology, IRCCS " Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Foggia, Italy
| | - Antonello Cuttitta
- Unit of General Surgery 2nd and Thoracic Surgery, IRCCS " Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Foggia, Italy
| | - Marco Taurchini
- Unit of General Surgery 2nd and Thoracic Surgery, IRCCS " Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Foggia, Italy
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Kim CH, Kim EJ, Lim JK, Yoo SS, Lee SY, Cha SI, Park JY, Lee J. Comparison of exogenous and endogenous lipoid pneumonia: the relevance to bronchial anthracofibrosis. J Thorac Dis 2018; 10:2461-2466. [PMID: 29850153 DOI: 10.21037/jtd.2018.04.06] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Lipoid pneumonia, caused by the accumulation of lipids in the alveoli, is classified into two forms (exogenous vs. endogenous) according to the source of the lipid exposure. There are no data directly comparing patients with exogenous and endogenous lipoid pneumonia. All patients who were diagnosed with lipoid pneumonia between January 2008 and December 2016 at Kyungpook National University Hospital, a tertiary referral hospital in South Korea, were retrospectively reviewed. The clinical, radiologic, and bronchoscopic findings for the two forms of lipoid pneumonia were compared. A total of 13 patients who met the criteria for a confirmed diagnosis of lipoid pneumonia were included. Dyspnea at presentation, predominant lower lobes involvement, bronchial anthracofibrosis (BAF), and recurrent episodes were more frequent in patients with the endogenous form than in those with the exogenous form. Of them, a notable finding was that BAF was identified in all five patients with the endogenous form, whereas BAF was observed in only one of the eight patients with the exogenous form (P=0.005). This finding suggests that BAF may be associated with endogenous form. Awareness of this association between endogenous lipoid pneumonia and BAF may help clinicians avoid delaying diagnoses.
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Affiliation(s)
- Chang Ho Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Eun Jin Kim
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Jae Kwang Lim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Soo Yoo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Shin Yup Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jae Yong Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Okamori S, Asakura T, Nishimura T, Tamizu E, Ishii M, Yoshida M, Fukano H, Hayashi Y, Fujita M, Hoshino Y, Betsuyaku T, Hasegawa N. Natural history of Mycobacterium fortuitum pulmonary infection presenting with migratory infiltrates: a case report with microbiological analysis. BMC Infect Dis 2018; 18:1. [PMID: 29291713 PMCID: PMC5748953 DOI: 10.1186/s12879-017-2892-9] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 12/07/2017] [Indexed: 11/23/2022] Open
Abstract
Background Presence of Mycobacterium fortuitum in respiratory tracts usually indicates mere colonization or transient infection, whereas true pulmonary infection occurs in patients with gastroesophageal disease. However, little is known about the diagnostic indications for true M. fortuitum pulmonary infection and the natural history of the disease. Case presentation A 59-year-old man was referred to our hospital for treatment against M. fortuitum pulmonary infection. Fifteen years before the referral, he underwent total gastrectomy, after which he experienced esophageal reflux symptoms. After the referral, the patient was closely monitored without antimicrobial therapy because of mild symptoms and no pathological evidence of M. fortuitum pulmonary infection. During the observation, chest imaging showed migratory infiltrates. Two years after the referral, his lung biopsy specimen revealed foamy macrophages and multinucleated giant cells, indicating lipoid pneumonia. However, he was continually monitored without any treatment because there was no evidence of nontuberculous mycobacterial infection. Four years after the referral, he developed refractory pneumonia despite receiving adequate antibiotic therapy. After confirmation of granulomatous lesions, multiple antimicrobial therapy for M. fortuitum resulted in a remarkable improvement with no exacerbation for over 5 years. Random amplified polymorphic DNA polymerase chain reaction analysis revealed identical M. fortuitum strains in seven isolates from six sputum and one intestinal fluid specimens obtained during the course of the disease. Conclusions We have described a patient with M. fortuitum pulmonary infection who presented with migratory infiltrates. The pathological evidence and microbiological analysis suggested that M. fortuitum pulmonary infection was associated with lipoid pneumonia and chronic exposure to gastrointestinal fluid. Therefore, physicians should carefully monitor patients with M. fortuitum detected from lower respiratory tract specimens and consider antimicrobial therapy for M. fortuitum infection when the patient does not respond to adequate antibiotic therapy against common pneumonia pathogens.
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Affiliation(s)
- Satoshi Okamori
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Tomoyasu Nishimura
- Keio University Health Center, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Eiko Tamizu
- Keio University Health Center, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Mitsunori Yoshida
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, 4-2-1 Aobacho, Higashimurayama, Tokyo, 189-0002, Japan
| | - Hanako Fukano
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, 4-2-1 Aobacho, Higashimurayama, Tokyo, 189-0002, Japan
| | - Yuichiro Hayashi
- Division of Diagnostic Pathology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Masaki Fujita
- Department of Respiratory Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Yoshihiko Hoshino
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, 4-2-1 Aobacho, Higashimurayama, Tokyo, 189-0002, Japan
| | - Tomoko Betsuyaku
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Naoki Hasegawa
- Center for Infectious Diseases and Infection Control, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
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Mascarel P, Dierick A, Elbok M. [About an unusual case of lipoid pneumonia]. Rev Pneumol Clin 2016; 72:296-299. [PMID: 27561978 DOI: 10.1016/j.pneumo.2016.06.001] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 06/04/2016] [Accepted: 06/09/2016] [Indexed: 06/06/2023]
Abstract
Lipoid pneumonia, although uncommon, should be considered when patients had a chronic pneumonia. We report a case of a 40-year-old female who presented with a chronic pneumonia. The CT-scan analysis, then the bronchoalveolar lavage, revealed a lipoid pneumonia. This lipoid pneumonia was caused by chronic inhalation of niaoulis vapors. This etiology has not been described in the literature. Alveolar condensation disappeared one month after bronchoalveolar lavage. This suggests that bronchoalveolar lavage may contribute to opacity regression besides exogenous lipid eviction.
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Affiliation(s)
- P Mascarel
- Service de radiologie clinique Ste-Clotilde, 127, route du Bois-de-Nèfles, 97400 Ste-Clotilde, Réunion.
| | - A Dierick
- Résidence Rodrigues, 7, rue Henri-Cornu-Technopole, 97400 Ste-Clotilde, Réunion
| | - M Elbok
- Clinique Ste-Clotilde, 127, route du Bois-de-Nèfles, 97400 Ste-Clotilde, Réunion
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Abstract
OBJECTIVE To analyze the clinical and imagenological characteristics of acute Exogenous lipoid pneumonia (ELP), explore its risk factors, and assess the potential role of multiple bronchoalveolar lavages (BALs) and steroid therapy in the treatment of children with acute ELP. METHODS Between May 2011 and July 2014, 33 pediatric patients with pneumonia caused by aspiration of oil-based substances were admitted to the Guangzhou Women and Children's Medical Center, Guangdong, China. Data on the demographics of these patients, as well as that on clinical presentations, imagenological characteristics, history of ingestion, laboratory observations, treatment protocol, response to therapy, BAL findings, and treatment outcomes were collected. RESULTS The study group consisted of 23 boys (69.7 %) and 10 girls (30.3 %), with ages ranging from 4 mo to 4 y. They were admitted to the hospital 2 h to 13 d after ingesting the oil-based substance. By the time of admission, most patients presented with respiratory distress and other symptoms, including tachypnea (n = 21), cough (n = 25), mild fever (n = 18), progressive dyspnea (n = 12), and pneumorrhagia (n = 5); six patients received mechanical ventilation because of complicated respiratory distress syndrome. The most common laboratory observations were leukocytosis (25 of 33, 75.8 %), neutrophilia (23 of 33, 69.7 %), and anemia (8 of 33, 24.2 %). Serum biochemical examination showed elevated sedimentation rates (24 of 33, 72.7 %), lactate dehydrogenase levels (18 of 33, 54.5 %), and C-reactive protein levels (17 of 33, 51.5 %). The most common finding on computed tomography (CT) scans was areas of consolidation. Within the follow-up duration of 2 wk to 6 mo, all patients with clinical symptoms of ELP experienced remission, and none died. The CT scans of most of the cases were normal by 1 to 3 mo, except for two patients who showed complete improvement 6 mo after treatment. CONCLUSIONS It was found that multiple BALs combined with steroid therapy result in significant improvement of clinical, radiologic, and laboratory parameters in children with acute ELP. Further, some traditional practices may predispose children to ELP, even in the absence of underlying risk factors. Finally, pneumorrhagia and acute respiratory distress syndrome may be the main complications of acute ELP in children.
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Morita H, Arai S, Kurasawa K, Okada H, Tanaka A, Yamazaki R, Owada T, Maezawa R. Intensive immunosuppressive therapy for endogenous lipoid pneumonia associated with rheumatoid arthritis. Mod Rheumatol 2016; 28:1044-1048. [PMID: 27321430 DOI: 10.1080/14397595.2016.1193270] [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] [Indexed: 10/21/2022]
Abstract
Endogenous lipoid pneumonia is an uncommon inflammatory pulmonary disease that is caused by lipids from an endogenous source, the treatment for which has not been established. We report the first case of endogenous lipoid pneumonia presenting as lung consolidation and which was associated with rheumatoid arthritis. Treatment was successful with intensive immunosuppressive therapy. When a physician finds lung consolidation in a patient with active rheumatic disease, lipoid pneumonia should be considered.
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Affiliation(s)
- Hiroko Morita
- a Clinical Immunology , Dokkyo Medical University School of Medicine , Mibu , Tochigi , Japan
| | - Satoko Arai
- a Clinical Immunology , Dokkyo Medical University School of Medicine , Mibu , Tochigi , Japan
| | - Kazuhiro Kurasawa
- a Clinical Immunology , Dokkyo Medical University School of Medicine , Mibu , Tochigi , Japan
| | - Harutsugu Okada
- a Clinical Immunology , Dokkyo Medical University School of Medicine , Mibu , Tochigi , Japan
| | - Ayae Tanaka
- a Clinical Immunology , Dokkyo Medical University School of Medicine , Mibu , Tochigi , Japan
| | - Ryutaro Yamazaki
- a Clinical Immunology , Dokkyo Medical University School of Medicine , Mibu , Tochigi , Japan
| | - Takayoshi Owada
- a Clinical Immunology , Dokkyo Medical University School of Medicine , Mibu , Tochigi , Japan
| | - Reika Maezawa
- a Clinical Immunology , Dokkyo Medical University School of Medicine , Mibu , Tochigi , Japan
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Lin J, Huang LL, Zhang JW, Ye MH, Feng JX. Endogenous lipoid pneumonia presenting as solitary pulmonary nodule: a case report. Int J Clin Exp Pathol 2015; 8:9727-9730. [PMID: 26464746 PMCID: PMC4583978] [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] [Received: 06/27/2015] [Accepted: 07/29/2015] [Indexed: 06/05/2023]
Abstract
A 63-year-old woman complained of hemoptysis was admitted to our hospital. Chest computed tomography (CT) showed a solitary pulmonary nodule (SPN) arising from the lower lobe of the right lung which was considered as lung malignancy. The patient underwent video-assisted thoracoscopic surgery (VATS) of pulmonary wedge resection to remove the nodule. Diagnosis of lipoid pneumonia was established by multiple lipid-laden macrophages found in surgical specimen. As there was no history of inhalation or aspiration of lipid containing substances, she was diagnosed as endogenous lipoid pneumonia. The patient discharged from our hospital after surgery and with no recurrence in 9 months period.
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Affiliation(s)
- Jian Lin
- Department of Respiratory Medicine, Taizhou Hospital of Wenzhou Medical UniversityLinhai 317000, Zhejiang, P. R. China
| | - Ling-Ling Huang
- Department of Respiratory Medicine, Taizhou Hospital of Wenzhou Medical UniversityLinhai 317000, Zhejiang, P. R. China
| | - Jian-Wei Zhang
- Department of Pathology, Taizhou Hospital of Wenzhou Medical UniversityLinhai 317000, Zhejiang, P. R. China
| | - Min-Hua Ye
- Department of Cardiothoracic Surgery, Taizhou Hospital of Wenzhou Medical UniversityLinhai 317000, Zhejiang, P. R. China
| | - Jia-Xi Feng
- Department of Respiratory Medicine, Taizhou Hospital of Wenzhou Medical UniversityLinhai 317000, Zhejiang, P. R. China
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