A case report of exogenous lipoid pneumonia associated with avocado/soybean unsaponifiables

Abstract

BackgroundExogenous lipoid pneumonia is a rare disease resulting from intra-alveolar accumulation of lipids of mineral, vegetal, or animal origin, that induce a foreign body type of inflammatory reaction in the lungs. Gastroesophageal reflux disease and other esophageal abnormalities have often been associated with this disease.Case presentationWe herein report the case of an 83-year-old patient in whom a follow-up chest computed tomography scan, for a lingular consolidation, showed multifocal ground glass and consolidative opacities with areas of low attenuation, suggestive of exogenous lipid pneumonia. The patient had been on piascledine capsules (avocado/soybean unsaponifiables) for 20 years and had a hiatal hernia with documented gastroesophageal reflux disease. After thorough history taking, no other predisposing factors were found. The diagnosis was confirmed using oil red staining of bronchoalveolar lavage showing lipid-laden macrophages and extracellular lipid droplets.ConclusionsTo our knowledge, this is the first case of ELP secondary to avocado/soybean unsaponifiables in the literature.

Pattern of FDG-PET uptake in lipoid pneumonia simulating lung cancer

“…Recently, FDG-PET plays a crucial role on diagnosing lung cancers; however, pseudo-positive FDG uptake has been reported in lipoid pneumonia, resulting in the simulation of lung cancers [ [3] , [4] , [5] , [6] ]. We comprehensively searched English literature and summarized 9 cases of lipoid pneumonia conducting FDG-PET as presented in Table 1 [ [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] ].…”

“…CT-fat density was evaluated in 5 cases, in which 4 cases manifested spotty distribution. On FDG-PET, SUVs ranged between 3.2 and 11.6 [ [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] ] with an exception of negative uptake in one case [ 11 ]. In all cases, SUVs exceeded a threshold of 2.5 that was previously proposed for the best discrimination between benign and malignant solitary lung nodules [ 12 ], illustrating a limitation of SUV alone for discriminating from lung cancers.…”

Neumonía lipoidea exógena crónica y sobreinfección por Mycobacterium tuberculosis

“…La aspiración o inhalación de sustancias grasosas es el principal factor desencadenante, en especial, aceites de origen mineral, como parafina vaporizada o vaselina, que son una mezcla de hidrocarburos inertes saturados de cadena larga obtenidos del petróleo, que inducen una respuesta inflamatoria pulmonar de tipo cuerpo extraño. 4 Ciertas alteraciones anatómicas y funcionales faríngeas o esofágicas que causen trastornos de la deglución pueden incrementar el riesgo de aparición, tales como, divertículo de Zenker, fístula traqueoesofágica, hernia hiatal, reflujo gastroesofágico, acalasia, enfermedades neuromusculares que afecten la motilidad faríngea o el reflejo de la tos. 5 En sujetos normales, la aspiración guarda relación con su ocupación o hábitos, tales como…”