FIRE EATER'S LUNG

Abstract

SESSION TITLE: Medical Student/Resident Occupational and Environmental Lung Disease SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: A 24 year-old male without medical history presented with acute onset dyspnea, pleuritic chest pain and epigastric discomfort. He reported one episode of bloody emesis, bilateral pulsating frontal headache, and subjective fevers with chills. He had immigrated from Guatemala 8 months prior to current presentation. Occupational history revealed exposure to hydrocarbons – his job required him to siphon gasoline while trying to dilute paints. CASE PRESENTATION: Physical Exam:He was afebrile, tachycardic and normotensive, pulse oximetry of 92 – 99% on room air. He was in moderate respiratory distress. Auscultation revealed diffuse crackles throughout lung fields. Diagnostic Exam:Imaging revealed bilateral lower lobe patchy airspace opacities on chest x-ray and patchy alveolar consolidation in the lower lobes, right middle lobe and lingula on chest CT. Initial bronchoalveolar lavage of right middle lobe showed abundant macrophages and inflammatory cells with cultures negative. Autoimmune workup, respiratory viral panel, and pneumonia workup were all negative. Clinical course:Chest CT during the hospitalization demonstrated worsening lower lobes opacities with cavitation. The patient improved with supportive care and was discharged home after 23 days. Follow up chest CT 6 months later showed complete resolution of lung opacities with minimal linear scarring in lower lobes. Diagnosis:Fire eater’s lung (hydrocarbons aspiration) DISCUSSION: Fire eater’s lung, also known as hydrocarbon pneumonitis, is a rare disease that develops after aspiration of low viscosity, volatile hydrocarbons such as petroleum derivatives1. The low viscosity of hydrocarbons allows for rapid diffusion throughout the bronchial mucosa leading to an acute presentation of symptoms as seen in this patient1. Fire eater’s lung is characterized by acute onset of choking, coughing, respiratory distress, pleuritic chest pain, fever, and gastrointestinal symptoms1. Radiographic findings generally demonstrate patchy alveolar opacities localized in lower lungs that initially predominate on the right side that become confluent and dense within 24 hours2. The pathologic findings generally demonstrate necrotizing acute bronchiolitis and necrotizing acute fibrinous pneumonia3. The clinical picture of hydrocarbon pneumonitis mirrors that of bacterial pneumonia, but the results of the infectious workup are usually negative. Our patient’s exposure with siphoning gasoline raised the suspicion of fire eater’s lung. The course of fire eater’s lung usually resolves within a few weeks to 3 months1. The mainstay treatment is supportive, although glucocorticoids and antibiotics have been used in some cases. CONCLUSIONS: Hydrocarbon aspiration can cause acute respiratory failure and lung opacities. The majority of the cases resolve with supportive care. Clinicians should provide education about the risk of siphoning gasoline to prevent this complication. Reference #1: Franzen, Daniel et al. “Fire Eater’s Lung: Retrospective Analysis of 123 Cases Reported to a National Poison Center.” Respiration. 87.2 (2014): 98–104. Web. Reference #2: Gentina, T et al. “Fire-Eater’s Lung: Seventeen Cases and a Review of the Literature.” Medicine 80.5 (2001): 291–297. Web. Reference #3: Tas, Sule, Yasemin Durum, and Can Karaman. “Fire-Eater’s Pneumonia.” Diagnostic and Interventional Radiology 21.3 (2015): 267–268. Web. DISCLOSURES: No relevant relationships by Sujith Cherian, source=Web Response No relevant relationships by Rosa Estrada-Y-Martin, source=Web Response No relevant relationships by Brandilyn Monene, source=Web Response