Whole lung lavage in the setting of exogenous lipoid pneumonia

Introduction

Lipoid pneumonia results from lipid deposition in the lungs, arising either exogenously or endogenously. Exogenous lipoid pneumonia occurs from aspiration or use of oil-based products such as mineral oil or nasal topicals. Beyond removing the offending agent, treatment options in adults are limited. Corticosteroids may provide relief, but refractory cases necessitate alternative therapies. Whole lung lavage has shown promise in select pediatric and adult cases. We report a case of steroid-refractory exogenous lipoid pneumonia successfully treated with whole lung lavage.

Case presentation

A 56-year-old non-smoker with coronary artery disease and recurrent pneumonia presented with 3 months of fever, weight loss, night sweats, and dyspnea following COVID-19 infection the previous year. Imaging revealed multifocal ground-glass opacities and pleural effusions, with negative infectious workup. Despite corticosteroid treatment, symptoms recurred, leading to multiple Emergency Department visits. Biopsy via bronchoscopy confirmed exogenous lipoid pneumonia, attributed to chronic mineral oil use for constipation. Despite cessation of mineral oil and prolonged steroid courses, his condition worsened. Bronchoalveolar lavage revealed 59 % lipid-laden macrophages. A multidisciplinary team recommended whole lung lavage. The patient underwent the procedure on the left lung, was successfully extubated the following day, and discharged 4 days post-procedure.

Discussion

Exogenous lipoid pneumonia is typically managed by stopping the offending agent and corticosteroids, but no standard treatment exists for steroid-refractory cases. Whole lung lavage offers a potential option for symptomatic and imaging improvement. This case underscores the emerging role of whole lung lavage in severe, steroid-resistant exogenous lipoid pneumonia.