ACUTE RESPIRATORY DISTRESS SYNDROME CAUSED BY LIPOID PNEUMONIA IN A 44-YEAR OLD PATIENT WITH PERSISTENT FEVER

Abstract

Listen

Translate article

SESSION TITLE: Medical Student/Resident Lung Pathology SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Lipoid pneumonia is an uncommon, caused by inhalation of oily substances. It may present as chronic cough, or it may also present as acute respiratory syndrome. Its clinical manifestations are non-specific, and high degree of suspicion if highly required. CASE PRESENTATION: A 44-year old female, presented to ED was apparently well before admission, until 6 days prior to admission, patient had body malaise, headache, fever and abdominal pain; signs and symptoms persisted hence prompted consult. Denies cough, dyspnea, hemoptysis and chest pain. Patient is a known case of type 2 DM and has a history of elevated liver enzymes due to NAFLD, patient was prescribed with unnamed oil-based food supplements. Patient was admitted as a case of dengue fever with warning signs. Patient was awake, not in distress, with normal vital signs, however, febrile. the physical examinations findings are normal. Laboratory results revealed thrombocytopenia, leukopenia with lymphocytosis. Dengue NS1Ag, IgG and IgM was negative. Infused with intravenous hydration of isotonic solution at 120cc/hr. Despite the adequate hydration, patient was persistently febrile and platelet count are decreasing as well as the hemoglobin and WBC count. During the 5th hospital day, she had dyspnea, treated as a case of hospital acquired pneumonia, and was treated with piperacillin-tazobactam. Chest x-ray revealed infiltrates. Despite medical management, patient succumbed to death and was subjected for autopsy with significant findings in both lungs,there are lipid-laden macrophages seen. DISCUSSION: Lipoid pneumonia is uncommon and There is no available data regarding its incidence and prevalence locally. It is the first reported case in our institution. It can be exogenous or tendogenous; endogenous lipoid pneumonia usually occurs when mineral or vegetable oils are aspirated or inhaled, and the latter results from lipid accumulation within intra-alveolar macrophages in the setting of bronchial obstruction. Acute exogenous lipoid pneumonia is typically caused by an aspiration of petroleum-based products, such as aspiration during fire-eating demonstration and gas-siphoning. Chronic lipoid pneumonia presents after recurrent ingestion of oily substances. It typically presents with cough, dyspnea and fever, or asymptomatic. Radiological findings may mimic other lung diseases.The most commonly described feature is alveolar consolidations of low attenuation values, ground glass opacities with thickening of intralobular septa. The macrophages in lipoid pneumonia have at least some large vacuoles accompanied by a foreign body giant cell reaction, chronic inflammation elicited by the lipoid material. The treatment is removal of inciting factor and purely supportive. CONCLUSIONS: Lipoid pneumonia requires high degree of suspicion for diagnosis, and be considered as differential diagnosis in patients with persistent fever. Reference #1: Simmons Ashley MD, Rouf Emran MD , Et Al. Not Your Typical Pneumonia: A Case Of Exogenous Lipoid Pneumonia. J Gen Intern Med 22(11):1613–6 Reference #2: Christiani David C, M.D., M.P.H. Vaping-Induced Lung Injury. N Engl J Med, 2019 Reference #3: Betancourt Susan, Martinez-Jimenez Santiago, et al Lipoid Pneumonia: Spectrum of Clinical and Radiologic Manifestations. AJR:194, January 2010 DISCLOSURES: No relevant relationships by IMNAS MARIE CARINA ARQUILLO, source=Web Response