Lipoid pneumonia: An uncommon complication of a common environmental cleaner
American Journal of Respiratory and Critical Care Medicine
Introduction: Lipoid pneumonia is an uncommon presentation characterized by the presence of endogenous or exogenous lipids in the alveoli. Its presentation is insidious and non-specific with respiratory symptoms that include chronic dyspnea and cough, mimicking interstitial lung disease. Here, we present a case of young female who presented with lipoid pneumonia following repeated exposure to an oil-based cleaning product. Case: A 42-year-old African American female with a past medical history of asthma and pulmonary nodules presented with a two-week history of shortness of breath and non-productive cough. She was treated with a course of azithromycin and prednisone for presumed bronchitis as well as symbicort and albuterol for three weeks prior to presentation. Despite this, her symptoms persisted. Chest CT revealed multifocal patchy areas of ground-glass opacities involving the bilateral lower lung fields, multiple non-calcified pulmonary nodules and mild mediastinal and hilar lymphadenopathy. Further infectious and inflammatory evaluation revealed a positive mycoplasma IgM and an elevated angiotensin converting enzyme (ACE) level for which she was started on an additional course azithromycin and 60 mg of prednisone daily due to concern for sarcoidosis and prophylactic trimethoprim/sulfamethoxazole. She subsequently underwent an endobronchial ultrasound (EBUS) with bronchoalveolar lavage (BAL) and biopsy. Biopsy findings were consistent with chemical pneumonitis rather than sarcoidosis. Repeat chest CT showed marked improvement in parenchymal lung disease and lymphadenopathy but with a new left lower lobe focal consolidation, concerning for post-transbronchial biopsy hemorrhage as prior CT unremarkable. On further discussion with the patient, it was noted there was a temporal relationship between onset of her symptoms and a new petroleum based cleaner used at work. Prednisone was subsequently tapered and she was advised to use barrier protection when at work. Conclusion: Lipoid pneumonia is a rare clinical entity. The lack of specific clinical or radiographic findings often delays the diagnosis in the absence of high clinical suspicion. There are no radiologic findings that are pathognomonic for lipoid pneumonia. The main findings may mimic carcinoma, pneumonia, ARDS or a localized granuloma with airspace consolidation or ground-glass attenuation. Diagnosis is made following the demonstration of lipid-laden macrophages in the sputum, BAL or fine needle aspiration/biopsy of a radiographic lesion. As with other interstitial lung disease, a thorough clinical history is paramount for diagnosis. Treatment is variable, though avoidance of triggers and prolonged corticosteroid use have been proven to be most effective.
Mehndiratta R, Shams C, Leamon G, Cihewicz A, Nair G, Mina N. Lipoid Pneumonia: An Uncommon Complication of a Common Environmental Cleaner. InA49. CASE REPORTS IN LUNG DISEASE ASSOCIATED WITH INHALATIONAL EXPOSURES. Am J Respir Crit Care Med 2019;199:A1813 American Thoracic Society.