Tuberc Respir Dis.  2006 Feb;60(2):235-238.

Severe Exogenous Lipoid Pneumonia Following Ingestion of Large Dose Squalene: Successful Treatment with Steroid

• Choi HS
• Kwag HJ
• Chae SW
• Lim SY
• Lim SY

Abstract

Exogenous lipoid pneumonia (ELP) is an uncommon condition resulting from aspiration or inhalation of vegetable, animal or mineral oil. It results in foreign body type inflammatory reaction of the lung and can show various clinical presentations from asymptomatic incidental finding to severe pneumonia leading to acute respiratory failure. Although many cases have been reported, severe ELP requiring steroid or whole lung lavage for treatment is rare. We report a case of 51-year old man with esophageal cancer who developed severe ELP following ingestion of large dose shark oil (Squalene) and successfully treated with prednisolone.

Keyword

Lipoid pneumonia; Squalene; Steroid

MeSH Terms

Animals
Bronchoalveolar Lavage
Eating*
Esophageal Neoplasms
Foreign Bodies
Humans
Incidental Findings
Inhalation
Lung
Middle Aged
Mineral Oil
Pneumonia*
Prednisolone
Respiratory Insufficiency
Sharks
Squalene*
Vegetables
Mineral Oil
Prednisolone
Squalene

Figure

• 

  Figure 1 (A) On admission, chest radiograph shows diffuse bilateral ground-glass shadowing, especially over the middle and lower lung fields. (B) Chest radiograph shows almost complete resolution of both lung lesion after steroid therapy

• 

  Figure 2 High resolution computed tomographic scan of the chest demonstrates extensive bilateral ground-glass opacity in both lower lobe, right middle lobe and left lingular segment.

• 

  Figure 3 Bronchoalveolar lavage fluid obtained by bronchoscopy shows yellowish lipid layer on the surface.

• 

  Figure 4 Light microscopic finding from BAL shows numerous red staining positive fat materials (Oil Red O stain, ×400).

Reference

1. Spickard A 3rd, Hirschmann JV. Exogenous lipoid pneumonia. Arch Intern Med. 1994. 154:686–692.

2. Nogue S, Sanz P, Borondo JC, Picon M, de la Red G, Mestre G. Fatal lipoid pneumonia due to bronco-aspiration of isoparaffin after ingestion of an organophosphate insecticide. Acta Anaesthesiol Scand. 2003. 47:777–779.

3. Hyun JG, Rhee JH. Clinical investigation of lipoid pneumonia in adults. Tuberc Respir Dis. 1996. 43:965–975.

4. Wright BA, Jeffrey PH. Lipoid pneumonia. Semin Respir Infect. 1990. 5:314–321.

5. Gondouin A, Manzoni P, Ranfaing E, Brun J, Cadranel J, Sadoun D, et al. Exogenous lipid pneumonia: a retrospective multicentre study of 44 cases in France. Eur Respir J. 1996. 9:1463–1469.

6. Jeong KJ, Kim YE, Lim GJ, Suh KD, Kim JD, Lee JH, et al. A Case of lipoid pneumonia after ingestion of green perilla oil. Tuberc Respir Dis. 1999. 47:123–126.

7. Hussain IR, Edenborough FP, Wilson RS, Stableforth DE. Severe lipoid pneumonia following attempted suicide by mineral oil immersion. Thorax. 1996. 51:652–653.

8. Chang HY, Chen CW, Chen CY, Hsuie TR, Chen CR, Lei WW, et al. Successful treatment of diffuse lipoid pneumonitis with whole lung lavage. Thorax. 1993. 48:947–948.

9. Rossi SE, Erasmus JJ, Volpacchio M, Franquet T, Castiglioni T, McAdams HP. "Crazy-paving" pattern at thin-section CT of the lungs: radiologic-pathologic overview. Radiographics. 2003. 23:1509–1519.

10. Laurent F, Philippe JC, Vergier B, Granger-Veron B, Darpeix B, Vergeret J, et al. Exogenous lipoid pneumonia: HRCT, MR, and pathologic findings. Eur Radiol. 1999. 9:1190–1196.

11. Nicholson AG, Wells AU, Hooper J, Hansell DM, Kelleher A, Morgan C. Successful treatment of endogenous lipoid pneumonia due to Niemann-Pick Type B disease with whole-lung lavage. Am J Respir Crit Care Med. 2002. 165:128–131.

12. Ayvazian LF, Steward DS, Merkel CG, Frederick WW. Diffuse lipoid pneumonitis successfully treated with prednisone. Am J Med. 1967. 43:930–934.

13. Chin NK, Hui KP, Sinniah R, Chan TB. Idiopathic lipoid pneumonia in an adult treated with prednisolone. Chest. 1994. 105:956–957.

14. Haro M, Murcia I, Nunez A, Julia E, Valer J. Massive haemoptysis complicating exogenous lipid pneumonia. Eur Respir J. 1998. 11:507–508.