A 79‐year‐old white man went to the emergency room with complaints of right upper quadrant pain and got an abdominal CT scan done, which revealed some abnormality in his chest. He subsequently underwent a chest CT that was consistent with an infiltrate and mild ground‐glass densities surrounding the right middle lobe. Findings were concerning for malignancy among other differentials. He eventually underwent a fiber‐optic bronchoscopy with bronchoalveolar lavage and transbronchial lung biopsies, after multiple other tests, which showed the presence of early lipoid foamy histiocytes with large vacuoles, suggestive of lipoid pneumonia. On detailed discussion with the patient, a history of chronic constipation, for which he had been taking mineral oil every day in the mornings for many years, and of gastroesophageal reflux disease was obtained.
Lipoid pneumonia, an uncommon disease encountered in all age groups, may be endogenous or exogenous. About half of patients have no symptoms, with their disease being evident because of an abnormal chest x‐ray usually obtained for a different reason. This case presentation focuses on exogenous lipoid pneumonia. A rare form of nonresolving pulmonary infiltrate, exogenous lipoid pneumonia is a great mimicker. It usually presents as an insidious onset, chronic respiratory illness, especially when the exposure to fatty substance(s) is massive. It often is mistaken for bacterial pneumonia or malignancy. Reactions are usually seen with animal oils, for example, cod liver oil, fish oil, and mineral oils. Simple vegetable oils usually do not provoke any reaction and are removed by expectoration. The presence of concurrent debilitating illness and continued use of the agent predict a more progressive disease course. It is more likely to be seen in bed‐bound patients and infants. Superinfection with nontuberculous mycobacteria and cryptococcus may also occur because lipids enhance the growth of these organisms and impede their phagocytosis. Diagnosis is made usually by detection of fat‐laden macrophages in specimen from alveoli and lung tissue obtained by bronchoscopy. Complications may include hypercalcemia secondary to a granulomatous response or even bronchoalveolar carcinoma because mineral oil can be teratogenic, as formation of fibrous tissue is known to predispose to cancer. Treatment usually comprises discontinuing exposure to the offending agent, treating any complicating infection, treatment of reflux disease if present, and provision of supportive care.
This condition may present a diagnostic dilemma and is a perfect case to show hospitalists that as with most things in medicine, a thorough history will give a clue to the final diagnosis.
To cite this abstract:Naqvi S. Home Remedy, Bad Malady. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 303. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/home-remedy-bad-malady/. Accessed July 24, 2019.