A CASE OF EXOGENOUS LIPOID PNEUMONIA

Abstract

SESSION TITLE: Wednesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Exogenous lipoid pneumonia (ELP) is a rare form of pneumonia caused by inhalation or aspiration of a fatty substance. In adults, most cases result from the use of oil-based laxatives for the treatment of constipation, followed by the nasal instillation of oily products for chronic rhino pharyngeal diseases. We present a patient who presented with persistent infiltrates and was diagnosed with lipoid pneumonia on lung biopsy. CASE PRESENTATION: A 48 year old female with past medical history of severe gastroesophageal reflux disease and Barrett’s esophagus was referred to the pulmonary clinic for recurrent pneumonia. She had been having gradual exertional dyspnea over two years. She denied chronic cough, wheezing, hemoptysis or overt aspiration. Social history was unremarkable with exception for tobacco abuse. Physical examination revealed oxygen saturation of 93% on room air; symmetrical breath sounds without crackles or wheezing and had normal heart sounds. Investigations including blood chemistries and serologies were unremarkable. Her pulmonary function test revealed normal spirometry with moderate diffusion impairment. Computed tomography revealed ground glass opacities with consolidative changes, with primarily left lung involvement. She was managed as pneumonia with multiple courses of antibiotics but her symptoms persisted. On serial imaging, the ground glass changes remain unchanged. Diagnostic bronchoscopy with biopsy revealed nonspecific chronic inflammatory changes which were assumed to be due to subclinical aspiration. She was treated with anti-acid medications but she continued to have exertional dyspnea. Eventually, she underwent left video assisted thoracoscopic surgery for tissue biopsy and diagnosis was consistent with lipoid pneumonia. She later revealed that she had been using mineral oil laxatives daily over the prior years. She has since stopped the usage of mineral oils. She continues to be mildly symptomatic and has persistent imaging findings. DISCUSSION: ELP is a rare cause of dyspnea and recurrent pneumonia. The typical clinical presentation of this condition includes a chronic cough with or without dyspnea and the presence of diffuse interstitial infiltrates on imaging studies of the chest. However, patients with ELP can present with symptoms ranging from asymptomatic state to severe life threatening respiratory failure. The imaging findings present with varying patterns and distribution and are not diagnostic. As seen in our case, the diagnosis can be delayed because of rather nonspecific clinical features of the disease and lack of a careful history taking for potential chemical irritants. Often, the exposure is identified only retrospectively after the diagnosis is made. CONCLUSIONS: Physicians need to have a high index of suspicion for ELP when managing patients with chronic cough or dyspnea and should elicit a history of mineral oil ingestion. Reference #1: Simmons, A., Rouf, E., & Whittle, J. (2007). Not Your Typical Pneumonia: A Case of Exogenous Lipoid Pneumonia. Journal of General Internal Medicine, 22(11), 1613-1616. https://doi.org/10.1007/s11606-007-0280-7 Reference #2: Marchiori, E., Zanetti, G., Mano, C. M., & Hochhegger, B. (2011). Exogenous lipoid pneumonia. Clinical and radiological manifestations. Respiratory Medicine, 105(5), 659-666. https://doi.org/10.1016/j.rmed.2010.12.001 DISCLOSURES: No relevant relationships by Amirahwaty Abdullah, source=Web Response no disclosure on file for Conrad Schuerch