Aromatherapy May Not Be So Relaxing After All: A Case of Acute Eosinophilic Pneumonia

Abstract

Acute eosinophilic pneumonia (AEP) is a rare entity of eosinophilic lung diseases, with around 200 cases reported worldwide (1). The cause is unknown, but it has mostly been linked to cigarette smoking inhalation. We present a unique case of AEP associated with a history of deep inhalation of fragrance oil. CASE PRESENTATION:Our patient is a 19-year-old medically free female who presented to the emergency department (ED) complaining of acute cough, fever, and dyspnea which started one day after deeply inhaling fragrance oil while trying to open the bottle with her mouth. She was febrile, in respiratory distress with an Oxygen saturation of 51%. The patient was managed as a case of possible COVID infection. She was intubated and admitted to the ICU. She received Dexamethasone for 3 days. Afterward, she was extubated and discharged home on room air the next day. Four days later, she presented to the ED with a similar picture. Chest x-ray (figure 1) showed bilateral patchy opacities. Computed tomography of the chest (CT) showed bilateral areas of consolidation and ground-glass opacities (figure 2). She was started empirically on antibiotics and a single dose of Hydrocortisone intravenously prior to CT scan as premedication protocol for Intravenous Contrast. Clinical, biochemical, and radiological improvement were noticed the next day. On the fourth day of admission, she became febrile and required more oxygen with an increase in neutrophils. At this point, she was started on Methylprednisone for a suspected diagnosis of acute eosinophilic pneumonia. The patient's condition improved with steroids. Bronchoalveolar lavage fluid analysis showed a WBC count of 614 cells /cumm with eosinophils of 84%. The patient was discharged home on prednisone 50mg which was tapered off within six weeks. On a follow-up clinic visit, the patient had complete resolution of her symptoms and her chest X-ray showed no lung infiltrates (figure 1 and 2).DISCUSSION: Acute eosinophilic pneumonia (AEP) is a rare disease with few reported cases worldwide. It usually presents similarly to pneumonia and acute respiratory distress syndrome. The cause of AEP is unknown but it has been suggested to be the result of an acute hypersensitivity reaction to an unknown allergen in a previously healthy individual (2) such as smoking. Our patient is the first case of AEP to occur after deep and sudden inhalation of fragrance oi which was made up of essence, scent stabilizer, deionized water, and ethyl alcohol. Our patient fulfills all the clinical criteria for AEP diagnosis.The mainstay of treatment in AEP is corticosteroids and patients usually have a rapid response as clinical recovery happens after 3 days of steroids (3). Prognosis in AEP is excellent with rapid initiation of steroids (1). CONCLUSIONS:We reported a unique case of AEP that occurred post fragrance oil inhalation and was resolved rapidly and completely with steroids.

Acute eosinophilic pneumonia following aromatherapy with essential oil

“…In recent years, a few cases of AEP associated with aromatherapy using essential oil have been reported [ 13 , 14 ]. However, this is not yet to known to clinicians.…”

Aromatherapy Apropos of Normal Flora: Friend or Foe?

“…: peppermint oil toxicity) 7 . Recently, acute eosinophilic pneumonia cases were confirmed after aromatherapy inhalation by healthy and asthma patients who compliantly administer albuterol and corticosteroids inhalers [47][48][49] . Yet, under-reporting of AEs remains a significant problem hindering understanding and assessing the true repercussions of aromatherapy and drawing practical instructions for dos and don'ts.…”

Aromatherapy in the Treatment of Seasonal Respiratory Viral Infections

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