SESSION TITLE: Diffuse Lung Disease Cases
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Monday, October 26, 2015 at 03:15 PM - 04:15 PM
INTRODUCTION: Lipoid pneumonia (LP) is a rare condition resulting from the aspiration or inhalation of lipid substances. Till date, an association between e-cigarettes and exogenous LP has been proposed in a single case study.
CASE PRESENTATION: A 31 year-old female smoker was admitted to the hospital for progressive dyspnea and cough. Physical exam was remarkable for bibasilar rales and low-normal oxygen saturation. Chest x-ray noted bilateral air space opacities. Despite treatment with empiric antibiotics, she became increasingly hypoxic and was intubated due to concerns of acute respiratory distress syndrome. Blood and sputum cultures were negative. CT of the chest (Fig 1) revealed diffuse ground-glass opacities with interlobular septal thickening consistent with ‘crazy paving’ pattern. Bronchoalveolar lavage (Fig 2) showed reactive pneumocytes and alveolar macrophages with positive staining (Oil-Red-O) for lipid content. She was started on intravenous steroids. Given the temporal association of recent three month e-cigarettes use and characteristic findings, she was diagnosed with LP. Patient noted rapid improvement with cessation of e-cigarettes and systemic steroids.
DISCUSSION: Exogenous LP is an infrequent inflammatory disease, historically associated with use of laxatives and oil-based nasal solutions. Symptoms are non-specific and may be mistaken for pneumonia. Our patient started using e-cigarettes in an attempt to quit smoking. She endorsed frequent coughing with e-cigarettes and it is suspected that she aspirated the lipid contents into her airways which were subsequently taken up by alveolar macrophages, accumulated in the interstitial space and manifested as LP. Compared to prior reported cases, our patient had a relatively acute and severe presentation, requiring intubation. Cessation of exposure typically resolves the symptoms. However, in severe cases, it can progress to fibrosis and chronic respiratory failure. Steroids are recommended for severe cases but evidence is lacking.
CONCLUSIONS: Our case highlights a side effect of e-cigarettes presenting as acute severe exogenous LP. Growing use of e-cigarettes among the smokers and its unregulated availability raises concern for emergence of such adverse effects. Extreme caution is recommended to consider e-cigarettes as effective nicotine replacement therapy.
Reference #1: Betancourt, S, Martinez-Jimenez, S et al. Lipoid Pneumonia: Spectrum of Clinical and Radiologic Manifestations. Am J of Roentgenol. 2010;194(1):103-9
DISCLOSURE: The following authors have nothing to disclose: Sujal Modi, Rahul Sangani, Ahmad Alhajhusain
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