A Case of Exogenous Lipoid Pneumonia in a Critically Ill Patient

Abstract

Introduction:Lipoid pneumonia is a rare condition in which lipid molecules enter the alveoli. This condition usually manifests as hypoxemic respiratory failure after exogenous usage of different consumer products, including Vaseline, Vicks VapoRub and lip gloss, and occupational exposure in lubricant production, machine cleaning, and spray painting. We report a 79-year-old patient who presented with acute hypoxemic respiratory failure secondary to lipoid pneumonia. Case Presentation:A 79-year-old female with PMH of depression, chronic neck and back pain PTSD, HTN, HLD who presented to our institution with a chief complaint of non-productive cough and dyspnea on exertion for greater than a month. CXR showed diffuse bilateral interstitial opacities. CT imaging showed multifocal confluent geographic areas of ground-glass opacities in crazy paving patters, suggestive of alveolar pathology. Connective tissue disorders, respiratory cultures, and multiple COVID-19 tests were negative. BNP was normal. She initially required high flow oxygen with 80% FIO2. Steroids were started without improvement. The patient underwent bronchoscopy with BAL for suspected PAP, HP, and to rule out DAH. BAL showed lipid-laden macrophages on oil red o stain, and periodic acid shift stain was negative. The patient subsequently reported continuous Vicks vapor rub for many years, which was likely the reason for lipoid pneumonia development. Discussion:Lipoid pneumonia is a rare condition in which lipid molecules occupy intraalveolar space and are subsequently found in alveolar macrophages2. The exact mechanism is unknown;however, the pathogenesis and severity are related to the amount of inhaled materials used3. Lipoid pneumonia symptoms typically are chronic cough and progressive dyspnea on exertion. Recently, exogenous lipoid pneumonia has been linked to E-cigarettes usage4. Our case underlines the importance of keeping high clinical suspicion of lipoid pneumonia as a potential cause of dyspnea in patients with crazy paving patterns on CT scan. Taking a detailed history is essential in making the correct diagnosis.Conclusion Lipoid pneumonia is a rare diagnosis caused by inhaling different lipids containing materials. Physicians should be aware of this etiology as a possible differential diagnosis in patients admitted with acute hypoxemic respiratory failure.