LIPOID PNEUMONIA, AN UNEXPECTED DIAGNOSIS IN A HEALTHY MIDDLE-AGED PATIENT

Abstract

SESSION TITLE: Medical Student/Resident Occupational and Environmental Lung Diseases SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Lipoid pneumonia is a rare pneumonitis most often caused by aspiration of over-the-counter oil regimens such as nasal spray or mineral oil. The disease typically occurs in patients who are elderly or who have disorders that affect swallowing such as achalasia or reflux. CASE PRESENTATION: A 56-year-old woman presented to her regular doctor with complaint of left chest pain with deep breaths without coughing or fever. A Chest x-ray was performed, revealing bibasilar airspace disease in her right middle and left lower lobes. She was prescribed levofloxacin for 14 days. Her next x-ray showed no change to the infiltrates present. A Chest CT scan was obtained and confirmed dense left lower and right middle lobe consolidations without cavitation or malignant appearing pulmonary lesions. She was prescribed a second round of the same antibiotic in addition to prednisone. She was seen again in one month with improved symptoms, but she continued to show infiltrates on imaging. A CBC, ESR/CRP, Histoplasma, Legionella, Mycoplasma, and Blastomyces antibodies had all returned negative. She was then scheduled for CT guided biopsy of the left infiltrate. The sample ultimately showed lipid-laden “foamy” macrophages with some alveolar hyperplasia consistent with lipoid pneumonia. Further questioning revealed that she had been using mineral oil for several years before quitting but never noticed difficulty with swallowing and had no history of reflux, achalasia, or any neuromuscular disease. DISCUSSION: This patient’s history points to an exogenous source for her lipoid infiltration. Clinically, exogenous lipoid pneumonia can present in many ways, including severe shortness of breath with chest pain or asymptomatic. Our patient had both these presentations during her course. The current recommendations are to remove the potential causative agent and provide supportive care. Antibiotics and steroids have not been consistently shown to be effective in treatment. Our patient failed to see improvement with two long antibiotic courses and a steroid burst but symptoms gradually subsided after she had stopped ingesting oil. Lipoid pneumonia can lead to unnecessary administration of antibiotics and steroids as it did in our patient. It is also important to note also that our patient contracted this disease despite having none of the typical risk factors. CONCLUSIONS: This case highlights why it is important to consider this diagnosis of lipoid pneumonia in patients with a history of ingesting oil substances even in the absence of typical risk factors. Reference #1: Kuroyama M et al. Exogenous lipoid pneumonia caused by repeated sesame oil pulling: a report of two cases. BMC Pulm Med. 2015 Oct 30;15:135 Reference #2: Prasad KT et al. An Unusual Cause of Organizing Pneumonia: Hydrocarbon Pneumonitis. J Clin Diagn Res. 2017 Jun;11(6):OD03-OD04 Reference #3: Tavare AN et al. Exogenous Lipoid Pneumonia Mimicking Multifocal Bronchogenic Carcinoma. J Thorac Oncol. 2015 Dec;10(12):1809-10 DISCLOSURES: No relevant relationships by Clifford Hecht, source=Web Response