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A6651 - Lipoid Pneumonia, an Unexpected Diagnosis in a Healthy Middle-Aged Patient
Author Block: C. Hecht1, S. K. Komanapalli2; 1Internal Medicine, Indiana University Health Ball Memorial Hospital, Muncie, IN, United States, 2Pulmonary Medicine, IUH Ball Memorial Physicians, Muncie, IN, United States.
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: 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. This case highlights why it is important to consider this diagnosis in patients with a history of ingesting oil substances even in the absence of typical risk factors.