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: Exogenous lipoid pneumonia (ELP) is a rare form of pneumonia caused by inhalation or aspiration of fatty substances. ELP has been often reported with the inhalation or ingestion of petroleum jelly, mineral oils, laxatives and nasal drops. Occupational exposures known to be associated with such risk include gas station workers, exposed to inhalation of hydrocarbons, and magicians who perform fire eating stunts.
CASE PRESENTATION: A 63 year old lady was referred to the pulmonary clinic for evaluation of a non productive cough for 2 months, her medical history included type 1 DM, cholelithiasis and dyslipidemia, but denied any history of pulmonary disease. She worked as a Hibachi restaurant owner where she had also worked as a chef for more than 25 years since she first emigrated from Japan to the USA. Her physical examination was remarkable for fine bibasilar inspiratory crackles. CXRshowed bilateral patchy and reticular opacities over both lower lung zones. CT chest (Figure 1) showed bilateral lower lobe predominant ground glass opacities with lung fibrosis and early honey combing. Serological workup was negative for connective tissue and collagen vascular diseases. A VATS lung biopsy (Figure 2) revealed an active cellular chronic interstitial pneumonitis, characterized by heavy bronchiolocentric lymphoplasmasitic infiltrates and multinucleated giant cells containing cholesterol clefts and lipid laden macrophages.
DISCUSSION: ELP is an uncommon condition resulting from aspirating or inhaling fat-like material. Symptoms can vary significantly among individuals, ranging from asymptomatic to severe, life-threatening disease. There are no defined treatment guidelines; however, the key measure in halting disease progression is correctly identifying and discontinuing the exposure.
CONCLUSIONS: Diagnosis of ELP requires a careful and detailed history for any occupational or accidental exposures to oil inhalation, and the presence of lipid-laden macrophages in sputum or BAL. A lung biopsy will often show multiple lipid-laden macrophages with an airway-centric chronic granulomatous inflammation and fibrosis.
Reference #1: Spickard A 3rd, Hirschmann JV.Exogenous lipoid pneumonia. Arch Intern Med. 1994 Mar 28;154(6):686-92.
Reference #2: Venkatnarayan K, Madan K, Walia R, et al."Diesel siphoner's lung": Exogenous lipoid pneumonia following hydrocarbon aspiration. Lung India. 2014 Jan;31(1):63-6.
Reference #3: Shaikh AY, Oliveira PJ.Exogenous lipoid pneumonia (fire-eater's lung). Am J Med. 2014 Feb;127(2):e3-4.
DISCLOSURE: The following authors have nothing to disclose: Basheer Tashtoush, Ali Varasteh, Roya Memarpour, Franck Rahaghi, Anas Hadeh, Laurence Smolley
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