INTRODUCTION: Lipoid Pneumonia is a pulmonary disorder that results from the deposition of lipids in the alveoli, causing acute or chronic inflammation. Albeit rare, the most common form of this disease occurs from unintentional inhalation or aspiration of exogenous oils found in oral laxatives, balms, mineral oils or aerosolized droplets.
CASE PRESENTATION: A previously healthy 33 year-old woman presented with acute onset of pleuritic chest pain, palpitations and severe dizziness. She also reported gradual onset of exertional dyspnea in the weeks leading up to the presentation. Her medical and family history was otherwise unremarkable. She worked as a hair stylist throughout her career. Her initial physical examination was remarkable for mild tachycardia, loud P2 and desaturation up to 82% after minimal exertion on room air. Her routine labs, EKG and two-view chest radiograph were all negative. A computer tomography (CT) scan of the chest with intravenous contrast was done to rule out pulmonary embolism (PE) and showed ground-glass consolidations in both lower lung fields and peripherally in the upper lung fields with no evidence of PE. Trans-thoracic echocardiography revealed a hypokinetic and dilated right ventricle with estimated pulmonary artery pressure 75-80mmHg. Pulmonary function testing was consistent with moderate restrictive lung impairment with evidence of air-trapping. A decision was made that the patient’s diagnosis would be best elucidated via lung biopsy using video-assisted thoracoscopic surgery. A wedge resection of lung was obtained and demonstrated evidence of lipoid pneumonia with acute interstitial pneumonitis and alveolar cell hyperplasia. A Trichrome stain showed minimal increase in fibrosis. Referring back to her history, she admitted using several types of spray-on hair sheens in her salon, which create substantial potential for aerosolized inhalation of oil-based droplets and was considered the mode of exposure in her case. Treatment was initiated with intravenous steroids followed by a tapering dose of oral prednisone. The patient was instructed to avoid oil-based aerosolized hair sheen applications. On follow up visit she reported complete resolution of her symptoms. Repeat Pulmonary function testing revealed only minimal restrictive lung impairment with normal diffusion, her forced vital capacity increased from 1.55L to 2.62L. Repeat Trans-thoracic echocardiography revealed normalization of right ventricle function with improved pulmonary artery pressure to 43mmHg.
DISCUSSION: Most cases of lipoid pneumonia occur from aspiration or inhalation of mineral oil, especially in patients with impaired protective mucociliary clearance. The source of the oil commonly is oil-based laxatives, excessive use of lip balm or flavored lip gloss, or traditional folk remedies using oil based product for various purposes. Other unusual sources, such as smoking black fat tobacco in Guyana and excessive use of industrial lubricants and more peculiar ones, such as inhaled burning fat in a fire fighter and fire-eater have also been reported. Our case is unique in the sense that it affected predominantly peripheral area of lung in contrast to literature supporting peripheral sparing in cases of exogenous lipoid pneumonia.
CONCLUSIONS: Exogenous lipoid pneumonia should be included in differential diagnosis of patient presenting with respiratory complaints, positive occupational exposure history and ground glass infiltrate on CT images.
Reference #1 Anderson Spickard III, MD, J. V. Hirschmann, MD. Exogenous Lipoid Pneumonia. Arch Intern Med. 1994;154(6):686-692.
Reference #2 A. Gondouin, Ph. Manzoni, E. Ranfaing, J. Brun, J. Cadranel, D. Sadoun, J.F. Cordier, A. Depierre, J.C. Dalphin. Exogenous Lipid Pneumonia: a retrospective multicentre study of 44 cases in France. Eur Respir J, 1996, 9, 1463-1469.
Reference #3 3.Foe RB, Bigham RS. Lipoid pneumonia following occupational exposure to oil spray. JAMA 1954;155:33-34.
DISCLOSURE: The following authors have nothing to disclose: Matthew Michaels, Ajaykumar Patel, Zaza Cohen
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