Exogenous lipid pneumonia in old people caused by aspiration: Two case reports and literature review

Guo, Maoqing; Liu, Jianguo; Jiang, Bo

doi:10.1016/j.rmcr.2019.100850

Cited by 11 publications

(12 citation statements)

References 31 publications

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“…It has been established that inhaling various oils and high-molecular-mass lipophilic compounds causes this condition. Repeated or extended inhalation and pulmonary exposure to substances including mineral oil, squalene, Vaseline, olive oil, castor oil, omega-3-acid esters, rendered animal fat, and amiodarone are known to cause lipoid pneumonia [33][34][35][36][37][38][39]. Given that VEA is also a high-molecular-mass, semi-volatile and lipophilic oil with similar chemical and physical properties (logP oct/water >6 and boiling point >200 • C at 760 mmHg) as compounds that are known cause lipoid pneumonia, it is possible that VEA is causative or contributes to the development of EVALI and lipoid pneumonia.…”

Section: Vaping and Pulmonary Diseasementioning

confidence: 99%

Analysis of Cannabinoid-Containing Fluids in Illicit Vaping Cartridges Recovered from Pulmonary Injury Patients: Identification of Vitamin E Acetate as a Major Diluent

Duffy

et al. 2020

Toxics

114

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Beginning in June of 2019, there was a marked increase in reported cases of serious pulmonary injury associated with vaping. The condition, referred to as e-cigarette or vaping product use-associated lung injury (EVALI), does not appear to involve an infectious agent; rather, a chemical adulterant or contaminant in vaping fluids is suspected. In August of 2019, the Wadsworth Center began receiving vaporizer cartridges recovered from patients with EVALI for analysis. Having no a priori information of what might be in the cartridges, we employed untargeted analyses using gas chromatography-mass spectrometry and high-resolution mass spectrometry to identify components of concern. Additionally, we employed targeted analyses used for New York medical marijuana products. Here, we report on the analyses of 38 samples from the first 10 New York cases of EVALI for which we obtained cartridges. The illicit fluids had relatively low cannabinoid content, sometimes with unusual Δ9-/Δ8-tetrahydrocannabinol ratios, sometimes containing pesticides and many containing diluents. A notable diluent was α-tocopheryl acetate (vitamin E acetate; VEA), which was found in 64% of the cannabinoid-containing fluids. To investigate potential sources of the VEA, we analyzed six commercial cannabis-oil diluents/thickeners. Three were found to be >95% VEA, two were found to be primarily squalane, and one was primarily α-bisabolol. The cause(s) of EVALI is unknown. VEA and squalane are components of some personal care products; however, there is growing concern that vaping large amounts of these compounds is not safe.

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Section: Vaping and Pulmonary Diseasementioning

confidence: 99%

Analysis of Cannabinoid-Containing Fluids in Illicit Vaping Cartridges Recovered from Pulmonary Injury Patients: Identification of Vitamin E Acetate as a Major Diluent

Duffy

et al. 2020

Toxics

114

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“…The clinical manifestations of ELP are atypical and similar to those of other types of pneumonia, making it easy to misdiagnose. Additionally, they are a function of the type and amount of inhaled oily substance [ 10 ]. Betancourt et al [ 11 ] reported that ELP could be divided into acute and chronic forms.…”

Section: Discussionmentioning

confidence: 99%

Mycobacterium infection secondary to exogenous lipoid pneumonia caused by nasal drops: a case report and literature review

Wang

Lü

et al. 2023

BMC Pulm Med

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Background Exogenous lipoid pneumonia (ELP) is a rare disease and its diagnosis is often mistaken or delayed. Secondary infection with rapidly growing non-tuberculous mycobacteria is a rare complication of lipoid pneumonia. Case presentation A 38-year-old man presented with fever, cough, sputum, chest tightness, and shortness of breath. He had a 2-year history of allergic rhinitis and used liquid paraffin-containing menthol nasal drops daily. A chest CT scan showed multiple patchy ground glass opacities with blurred borders in both lungs, which were located in the inner pulmonary field and distributed along the bronchi. His ambient air PO2 was 63 mmHg. The patient was diagnosed with ELP by CT-guided lung biopsy. The nasal drops were discontinued, and systemic glucocorticoids were administered. During treatment, the pulmonary lesions deteriorated, and bronchoalveolar lavage was performed during bronchoscopy. Additionally, Mycobacterium abscessus was detected in the lavage fluid. Upon detection of a secondary M. abscessus infection, glucocorticoids were gradually discontinued, and anti-M. abscessus treatment was implemented. The patient’s symptoms rapidly ameliorated. After 11 months of anti-M. abscessus treatment, a repeat CT scan showed clear regression of the lung lesions. Conclusion Routine microbiological examination of samples, including sputum or alveolar lavage fluid, is necessary for patients with diagnosed or suspected ELP.

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“…This notion has prompted clinicians to perform whole lung lavage and repeated BAL to eliminate the foreign material, 5,[25][26][27][28] to prescribe immunosuppressants, namely corticosteroids, to mitigate the body's inflammatory response, or both. 5,25,29,30 Clinical and radiologic deterioration occurred in nearly two-fifths of the cohort (38% and 39%, respectively).…”

Section: Discussionmentioning

confidence: 99%

Presenting Clinicoradiologic Features, Causes, and Clinical Course of Exogenous Lipoid Pneumonia in Adults

Samhouri

Tandon

Hartman

et al. 2021

Chest

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BACKGROUND: Exogenous lipoid pneumonia (ELP) develops when lipid-containing substances enter the airways through aspiration or inhalation and incite an inflammatory response. The diagnosis of ELP often is difficult because findings may be nonspecific. The clinical course of ELP has not been well characterized.RESEARCH QUESTION: What are the presenting clinicoradiologic features of ELP, its causative agents, and clinical course? STUDY DESIGN AND METHODS: We searched the Mayo Clinic electronic medical records for patients diagnosed with ELP between 1998 and 2020. Inclusion diagnostic criteria were: (1) lipoid pneumonia (LP) on histopathologic examination, (2) lipid-laden macrophages in BAL fluid, or (3) fatty attenuation of parenchymal opacities on chest CT imaging. Additionally, all patients were required to have a clinician diagnosis of LP in the absence of conditions known to cause endogenous LP.RESULTS: Thirty-four patients were identified. Mean age was 71 years, with no sex predominance; one-half were asymptomatic. The diagnosis was confirmed by lung biopsy (including three lobectomies for suspected malignancy) in 71% of patients, CT scan in 24% of patients, and BAL in 5% of patients. Most patients manifested bilateral parenchymal opacities that commonly involved the lower lobes; fatty attenuation was identifiable in only 41% of patients. A causative substance was identified in 79% of patients, in most cases after the diagnosis was established. Over a median follow-up of 1.2 years, only 20% of patients with chronic respiratory symptoms improved, whereas 50% worsened. Over a median follow-up interval of 1 year, CT scan abnormalities improved or resolved in 33% of patients and progressed in 39% of patients. Patients who deteriorated were older, with a higher prevalence of GI disorders than those who remained stable or improved.INTERPRETATION: ELP often is asymptomatic and may not manifest fatty attenuation on chest CT imaging. Clinical and radiologic abnormalities persist or worsen in most affected patients, even when the causative agent is discontinued.

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Exogenous lipid pneumonia in old people caused by aspiration: Two case reports and literature review

Cited by 11 publications

References 31 publications

Analysis of Cannabinoid-Containing Fluids in Illicit Vaping Cartridges Recovered from Pulmonary Injury Patients: Identification of Vitamin E Acetate as a Major Diluent

Analysis of Cannabinoid-Containing Fluids in Illicit Vaping Cartridges Recovered from Pulmonary Injury Patients: Identification of Vitamin E Acetate as a Major Diluent

Mycobacterium infection secondary to exogenous lipoid pneumonia caused by nasal drops: a case report and literature review

Presenting Clinicoradiologic Features, Causes, and Clinical Course of Exogenous Lipoid Pneumonia in Adults

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