Exogenous Lipoid Pneumonia as a Contributory Factor in a Drug‐related Death

Abstract

Postmortem investigation often reveals various conditions, which may or may not have played a part in the death of the individual. The case of a 32-year-old woman is reported, with a long history of drug addiction. She was found dead in her bed. The autopsy revealed diffuse pulmonary edema with congestion of the lungs, brain, liver, and spleen. Microscopic examination of the lungs showed multiple intra-alveolar and interstitial foamy macrophages and extracellular fat droplets surrounded by polynuclear giant cells. Death was attributed to acute polydrug intoxication. As microscopic examination had revealed severe pulmonary lesions, lipoid pneumonia was considered as a contributing factor to death. Lipoid pneumonia is an uncommon entity with the characteristic radiograph features and histologic findings of alveoli filled with vacuolated, lipid-laden histiocytes. It can be either exogenous or endogenous in cause, based on the source of the lipid. Exogenous lipoid pneumonia usually results from aspiration or inhalation of fat-like material, such as mineral oil or petroleum-based lubricants and decongestants, resulting in pulmonary inflammatory reactions.

Exogenous lipoid pneumonia induced by nasal decongestant

“…5 In the advanced phases, signs of fibrosis or the form of distortion and honeycomb-type cystic alterations may also be present. 13 In the four clinical cases here described, the patients did not present significant respiratory symptoms due to lipoid pneumonia. PET CT scan can present misleading signs given a possible pathological uptake secondary to the inflammatory component of lipoid pneumonia.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] The reaction to the inhaled oil is initially characterized by an intraalveolar infiltration of macrophages accompanied from an acute inflammatory reaction. Fats from both endogenous and exogenous sources can build up in the lungs.…”

“…The clinical presentations vary from acute forms that present with symptoms similar to an infectious pneumonia with dyspnoea, cough and fever to chronic forms that may initially be asymptomatic or pauci-symptomatic with chronic cough and can occasionally be observed when chest X-rays are performed for screening purposes. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] The reaction to the inhaled oil is initially characterized by an intraalveolar infiltration of macrophages accompanied from an acute inflammatory reaction. The oil is rapidly phagocytized, resulting in a vacuolation of the macrophages.…”

False positive 18FDG PET-CT results due to exogenous lipoid pneumonia secondary to oily drug inhalation

“…We asked the patient precisely if he practiced nasal inhalation in any way and the patient finally reported a habit of snorting oily drugs for a recreational purpose, he could not specify the drug's name but described it as a liquid, oily like substance. Moreau et al [2] described a case of lipoid pneumonia in a patient who had snorted Subutex. Nasal inhalation of drugs, legal or illegal, is not spontaneously reported by patients.…”

“…Many different sources of oily substances have been described of mineral, vegetal, or animal origin, but inhalation of oily drugs during snorting for a recreational use has only been described once, in a postmortem analysis. [2] We present a case of exogenous lipoid pneumonia, presenting as a solitary pulmonary nodule, suspected to be secondary to aspiration of oily drugs during snorting.…”