Accidental Diesel Aspiration Leading to Lipoid Pneumonia: Lessons from a Young Patient’s Experience
Year: 2024
Type: article
Study design: Case Report
Abstract: Sir, A 26-year-old nonsmoker male arrived at the emergency department of a secondary care hospital with a 1-day history of right-sided chest pain, shortness of breath, and dry cough following the accidental ingestion of 50–60 ml of diesel when siphoning it from a container. He denied any history of prior lung infections, chronic lung disease, or other significant medical conditions. Upon arrival, his vital signs included a pulse rate of 110 beats/min, blood pressure of 112/70 mmHg, oxygen saturation of 92% on room air, and a respiratory rate of 24 breaths/min. During the physical examination, crepitations were noted in the right infrascapular and infra-axillary regions upon auscultation, with no other significant abnormalities detected. The initial laboratory tests, including a complete blood count and assessments of liver and kidney function, were all within normal limits. A chest X-ray taken at the time of admission revealed an opacity in the right lower zone, as depicted in Figure 1. Initially, the patient received nonsteroidal anti-inflammatory drugs and oxygen support (1–2 L/min). Repeat chest X-ray on day 4 showed increased right lower zone opacity and haziness, suggestive of pneumonia. The patient developed a fever on day 4 and was started on empirical antibiotic therapy with azithromycin and a third-generation cephalosporin. High-resolution computed tomography (HRCT) chest on day 6 revealed bilateral pleural effusion with underlying lung collapse/consolidation (worse on the right), areas of consolidation with air bronchograms, patchy ground-glass opacities, and fibroatelectatic changes in both the lungs. Based on the HRCT findings and history of diesel ingestion on day 6, the diagnosis of lipoid pneumonia was made. The patient was then started on corticosteroids (prednisolone 40 mg with a tapering schedule for two weeks) and continued on antibiotics. The patient’s pain improved significantly after starting corticosteroids. Repeat chest X-ray on day 10 showed improvement in consolidation, and the antibiotics were stopped. By day 14, the patient was asymptomatic with normal vital signs, laboratory tests, and chest X-ray. He was subsequently discharged to home. On follow-up after 1 month, the patient remained asymptomatic and had no activity limitation. Lipoid pneumonia is a rare lung condition marked by the buildup of fat particles within the alveoli.[1] Conventional risk factors include advanced age, prior stroke, alcohol use, seizures, and poor cough reflex; however, lipoid pneumonia is gaining renewed attention with the increasing use of exogenous causes including mineral oil, petroleum jelly, and certain laxatives.[2] Younger population with no underlying risk factors are often reporting with accidental aspiration of liquids.[3] Newer pathologies like e-Cigarette or Vaping Product Use-associated with Lung Injury pose a differential diagnosis and presents with respiratory symptoms with type 1 respiratory failure. Radiographic findings include diffuse bilateral ground-glass opacities, with a basilar predominance and sometimes subpleural or lobular sparing.[4] This condition poses significant diagnostic challenges, particularly in primary and secondary care settings, due to its nonspecific clinical features and imaging findings. These factors often result in misdiagnosis and mismanagement, highlighting the importance of thorough history taking in achieving an accurate diagnosis.[5] This case highlights the importance of considering lipid aspiration in patients with unexplained respiratory symptoms and radiological abnormalities. Clinicians should remain highly vigilant, particularly when encountering patients with unexplained respiratory symptoms and abnormal radiological findings.Figure 1: Chest X-ray on admission showing the right lower zone opacityFinancial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4404395356