A Case of Lipoid Pneumonia From Mineral Oil Aspiration With Delayed-Onset ARDS

Abstract

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: Hydrocarbons may facilitate aspiration via inhibition of the cough reflex. Very few observational studies have been performed to investigate the evolution and outcomes of hydrocarbon aspiration. CASE PRESENTATION: A 17-month-old boy presented to a local Emergency Department with signs of respiratory distress and concern for aspiration of baby oil. Initial chest radiograph showed bilateral perihilar and lower lobe infiltrates and antibiotic therapy was initiated. Within 24 hours of aspiration, the patient developed tachypnea and hypoxia with confirmed radiographic evolution of infiltrates. He was initiated on oxygen therapy and antibiotic coverage was broadened to treat lipoid aspiration pneumonia with superimposed bacterial pneumonia. In spite of combined therapy with antimicrobials and systemic steroids, he continued to be hypoxemic and ultimately required invasive ventilatory support for respiratory embarrassment. Initial bronchoalveolar lavage performed two weeks into his course showed opaque fluid with numerous inflammatory cells. Following his second therapeutic bronchoalveolar lavage, the patient was extubated and discharged home on supplemental oxygen therapy. DISCUSSION: This rare case depicts delayed-onset acute respiratory distress syndrome secondary to evolution of injury from hydrocarbon inhalation. The performance of multiple bronchoalveolar lavages within months of suspected aspiration has been shown to improve clinical outcomes and radiographic disease amongst children with lipoid aspiration. In our case, steroids may have decreased inflammation, but did not prevent lung injury. CONCLUSIONS: Very few observational studies have been performed describing the natural history of lipoid aspiration pneumonia, particularly among children. Most clinical outcomes are favorable, as in the case of our patient, but some children will develop pulmonary fibrosis. The utility of steroids remains controversial and warrants further investigation. This case emphasizes the importance of conversations regarding household safety at preventive health visits. Reference #1: Marchiori, E., Zanetti, G., Mano, C.M., Hochhegger, B. “Exogenous lipoid pneumonia. Clinical and radiological manifestations.” Respiratory Medicine. 2011. 105, 659-666. Reference #2: de Azevedo Sias, S.M., Ferreira, A.S., Daltro, P.A., Caetano, R.L., da Silva Moreira, J., Quirico-Santos, T. “Evolution of exogenous lipoid pneumonia in children: clinical aspects, radiological aspects and the role of bronchoalveolar lavage.” J Bras Pneumol. 2009. 35(9): 839-845. Reference #3: Sias, S.M.A, Daltro, P.A., Marchiori, E., Ferreira, A.S., Caetano, R.L., Silva, C.S., Muller, N.L., Moreira, J., Quirico-Santo, T. “Clinic and Radiological Improvement of Lipoid Pneumonia With Multiple Bronchoalveolar Lavages.” Pediatric Pulmonology. 2009. 44, 309-315. DISCLOSURE: The following authors have nothing to disclose: Ashley Devonshire, Sonal Malhotra, Mary Nevin No Product/Research Disclosure Information