Abstract

IntroductionHydrocarbon pneumonitis is an acute, intense pneumonitis resulting from aspiration of volatile hydrocarbon compounds with low viscosity and surface tension, most of which are members of the paraffin, naphthene and aromatic classes.Case presentationSix hours after participating in a party for teenagers, a 16-year-old boy developed dyspnea, cough, a fever (39°C) and chest pain. A chest radiograph showed infiltration in the right middle lobe. The patient reported alcohol abuse during the party and an episode of vomiting a few hours thereafter. He also reported practicing a fire-eating performance at the party using liquid paraffin, but was unaware of inhaling any of it. The radiographic infiltration was diagnosed as an aspiration pneumonia and he was treated at the local health center with antibiotics. Five days later, because of clinical deterioration, he was referred to a pulmonary clinic. A chest computed tomography scan was performed which showed consolidation with an air bronchogram in the right middle lobe and areas of atelectasis and ground glass opacities in the middle and lower right lobes. Spirometry revealed severe restriction of lung function. A bronchoscopy revealed inflamed, hyperemic mucosa. Bronchoalveolar lavage fluid revealed lipid-laden alveolar macrophages, which were detected by lipid staining, and neutrophilia. The patient was finally diagnosed with hydrocarbon pneumonitis and he was treated with systemic steroids and antibiotics. After 6 days of treatment there was complete clinical and significant radiologic regression.ConclusionHydrocarbon pneumonitis should be included in the differential diagnosis of pneumonias. Recent exposure to volatile hydrocarbons provides a basis for clinical diagnosis, as symptoms and radiologic findings are not specific.

Highlights

  • Hydrocarbon pneumonitis is an acute, intense pneumonitis resulting from aspiration of volatile hydrocarbon compounds with low viscosity and surface tension, most of which are members of the paraffin, naphthene and aromatic classes [1]

  • We report a case of hydrocarbon pneumonitis in a 16-yearold boy following liquid paraffin aspiration during a fireeating performance

  • Aspiration of volatile hydrocarbons, referred to as fire-eater's pneumonia, is an acute hydrocarbon pneumonitis occasionally seen in children and fire-eating per

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Summary

Conclusion

Hydrocarbon pneumonitis should be included in the differential diagnosis of pneumonias. These hydrocarbons are members of the paraffin, naphthene and aromatic classes, and are characterized by low viscosity and surface tension These substances have the ability to rapidly diffuse throughout the bronchial tree and disrupt the surfactant barrier. Fire-eater's pneumonia is generally a pseudo-infectious lung disease with an intense release of inflammatory cytokines; the use of steroids may improve the outcome in severely affected patients. This treatment is not standard and has been reported as not being reliably effective, the additional therapy of steroids in such a case remains controversial [1]. As in the case reported here, the patient may not be aware of having aspirated liquid during the fire-eating performance, leading to an incorrect diagnosis and delaying the correct diagnosis

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