Lipoid pneumonitis in a patient with an accidental ingestion of kerosene successfully treated with bronchoscopic segmental lavage and systemic steroid

Abstract

Rationale:Standard treatment of lipoid pneumonitis remains unclear. This study reports a case of kerosene pneumonitis successfully treated with systemic steroid and segmental bronchoalveolar lavage (BAL).Patient concerns:A 30-year-old woman referred to our hospital because of worsening of respiratory symptoms and fever despite antibiotic therapy following accidental ingestion of kerosene. She had no underlying disease.Diagnoses:Chest CT scan showed necrotic consolidation, ground glass opacity (GGO), bronchial wall thickening in the right middle/lower lobe (RML/RLL) and right pleural effusion. The lipoid pneumonitis was confirmed by identification of a lipid laden macrophage in bronchoalveolar lavage fluid.Interventions:The patient was treated with systemic corticosteroid and segmental BAL.Outcomes:The patient's symptoms rapidly improved after treatment and she was discharged one week after admission. A follow-up CT scan a week after discharge revealed marked resolution of consolidation. No recurrence was reported for 8 months.Lessons:This is the first case of kerosene pneumonitis successfully treated with systemic steroid and bronchoscopic segmental lavage therapy in Korea. Very few cases have been reported worldwide.

The efficacy and safety of therapeutic lung lavage for exogenous lipoid pneumonia: A systematic review

“…One patient endured recurrence, then was treated with corticosteroids for 6 weeks. 29 For radiological changes, the results of the last follow-up in the included studies were extracted. The radiological change was reported in 72 patients, of whom 41 (56.9%) patients had full resolution and 31 (43.1%) patients had partial resolution until the last followup.…”

Exogenous lipid pneumonia in old people caused by aspiration: Two case reports and literature review

“…The clinical presentation is nonspecific and consistent with pneumonia of other etiologies. Patients are likely to present with dyspnea and potentially a cough, chest pain, hemoptysis, intermittent fever, or leukocytosis may also manifest as well [23]. Betancourt et al [28] reported that ELP could be classified into acute and chronic forms.…”

“…Several case reports demonstrated the effectiveness of therapeutic lung lavage for lipoid pneumonia, which not only washed away lipids directly but also improved lung opacities [[15], [16], [17]]. Steroids are suggested for the treatment of lipoid pneumonia and have been proved successful in some cases, however, the efficiency of steroids mostly depending on the degree of intoxication [[5], [6], [7], [8], [9], [10],18,[22], [23], [24]]. Systemic steroid was administered initially at dose of 0.5mg/kg and gradually tapered off [31].…”

“…89 case reports were found. Upon the review of titles, abstracts, and full texts of these publications, we identified 22 articles (25 cases) describing exogenous lipid pneumonia caused by aspiration [[3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24]]. In particular, we found 3 articles describing 2 cases among these articles [17,20,24].…”

Acute exogenous lipoid pneumonia: Unusual presentation as cavitating lung disease with pneumothorax

“…Acute exogenous lipoid pneumonia is uncommon and is caused by ingestion and aspiration of a large quantity of a petroleum or lipid-based product. Inflammatory reaction in the lungs and resultant toxicity depends on the route and degree of exposure, and volatility, and viscosity of the product [ 1 ]. While ingestion or aspiration of kerosene, a petroleum distillate, is a common cause of accidental poisoning in children, is rarely seen in adults.…”