Lung Pathology |

Exogenous Lipoid Pneumonia Due to Intranasal Application of Vicks Vaporub FREE TO VIEW

Jeanne Kamal, MD; Jacques Azzi, MD; Dany Elsayegh, MD
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Staten Island University Hospital, Staten Island, NY

Chest. 2015;148(4_MeetingAbstracts):634A. doi:10.1378/chest.2254155
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SESSION TITLE: Lung Pathology Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Lipoid pneumonia occurs from the accumulation of lipids into the lungs. It can be caused by aspiration of fatlike compounds (exogenous form) in the lung, or by fatlike materials released from the lung itself (endogenous form). This condition is seldom described in the literature and treatment remains controversial. We present the case of a patient with exogenous lipoid pneumonia (ELP) that we believe resulted from nasal application of Vicks Vaporub.

CASE PRESENTATION: A 55-year-old gentleman diagnosed with Chronic Obstructive Disease presents to our care with exacerbation of his cough of two years duration. His vitals were within normal range except for an oxygen saturation of 93% on room air. The auscultation of his chest revealed decreased air entry bilaterally with bibasilar crackles and digital clubbing was noticed. Computerized tomography (CT)-scan of the chest showed extensive emphysema involving primarily the upper lung zones and extensive ground glass opacities with subpleural reticulations affecting the dependent lung zones (Figure 1). Upon further questioning of the patient, we found that for the past twenty years, he has been consistently applying Vicks Vaporub (1.2% eucalyptus oil, 4.8% camphor and 2.6% menthol) intranasally to relieve his nasal congestion.

DISCUSSION: The most common cause of ELP in adults’ remains aspiration of mineral oil.1 The lung reaction to aspirated oil is variable, mineral oil causes minimal inflammation and the pneumonitis is usually indolent. Diagnosis is established mainly on basis of history of exposure to lipid. Radiological findings and Bronchoalveolar lavage (BAL) can support the diagnosis but neither is characteristic alone. The most common findings on CT-scan are ground-glass opacities, consolidation, and interstitial abnormalities and BAL may show lipid-laden macrophages.1 The treatment ranges from lung lavage and corticosteroid for acute diffuse pulmonary damage to simply the avoidance of the offending product.

CONCLUSIONS: Inhalation of Vicks Vaporub was implicated in ELP confirmed by Transthoracic Fine Needle Aspiration.2 To our knowledge this is the first reported case of ELP due to intranasal application of Vicks Vaporub. Despite the lack of studies establishing a standardized treatment, the best approach remains to identify the offending agent and stop the exposure.

Reference #1: Hu X, Lee JS, Pianosi PT, Ryu JH. Aspiration-related pulmonary syndromes. Chest. 2015 Mar 1;147(3):815-23.

Reference #2: Gattuso P, Reddy VB, Castelli MJ. Exogenous lipoid pneumonitis due to Vicks Vaporub inhalation diagnosed by fine needle aspiration cytology. Cytopathology. 1991;2(6):315-6.

DISCLOSURE: The following authors have nothing to disclose: Jeanne Kamal, Jacques Azzi, Dany Elsayegh

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