Fire-Eater’s Lung

Gentina, T; Tillie‐Leblond, I.; Birolleau, Sophie; Saidi, F; Saelens, T; Boudoux, L; Vervloët, D.; Delaval, P; Ab, Tonnel

doi:10.1097/00005792-200109000-00002

Cited by 50 publications

(21 citation statements)

References 13 publications

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“…Up to now, there are only a few case reports [9,10,11,12,13] and one case series of 17 patients with FEL published [2]. In concordance with these publications, FEL predominantly occurs in young adults with a clear male predominance, and, generally, petroleum or its distillate is the offending agent.…”

Section: Discussionmentioning

confidence: 88%

“…Actually, FEL is provoked by the act of creating a fireball by breathing a fine mist of fuel over an open flame, which is called ‘fire breathing' (dragon's breath) [4,5,6]. The most likely mechanism for the development of FEL is that petroleum or other highly inflammable agents remaining in the mouth after flame blowing are aspirated with the subsequent deep inspiration [2]. Fire-breathing street artists commonly use petroleum or a volatile petroleum derivative, also called kerdan, which is produced by the distillation process of petroleum between 150 and 240°C [7].…”

Section: Discussionmentioning

confidence: 99%

“…Some street artists prepare individual mixtures composed of volatile substances other than kerdan, or they use other forms of petroleum distillates. As the physicochemical properties of hydrocarbons are different, individual mixtures may alter the clinical presentation, course and outcome of hydrocarbon pneumonitis giving the FEL a slightly variable clinical appearance [2]. Pulmonary injuries from hydrocarbons are due to their low viscosity, low surface tension, and high volatility.…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary injuries from hydrocarbons are due to their low viscosity, low surface tension, and high volatility. These characteristics reduce the effectiveness of the individual's cough and choke reflexes and, moreover, enable diffuse spreading of the fuel in the airway mucosa with a very high absorption rate, which leads to damage of bronchial mucosa and lung tissue [1,2]. …”

Section: Discussionmentioning

confidence: 99%

“…Due to the low viscosity of these hydrocarbons, there is a rapid diffusion throughout the bronchial mucosa sometimes leading to severe pulmonary and systemic inflammation after aspiration [1]. To date, the largest case series evaluating patients with FEL includes 17 cases only [2]. Thus, the optimal management of FEL has not yet been determined, and some controversies exist, particularly regarding the initiation of antibiotic therapy and administration of glucocorticoids.…”

Section: Introductionmentioning

confidence: 99%

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Fire Eater's Lung: Retrospective Analysis of 123 Cases Reported to a National Poison Center

et al. 2013

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Background: Fire eater's lung (FEL) is a distinct form of acute chemical toxic pneumonitis, which is caused by aspiration of flammable petrochemical derivatives used by street performers for ‘fire eating'. The optimal management of this condition has not yet been determined. Objective: The aim of this study was to investigate patient characteristics, clinical features, treatment, and outcome of FEL. Methods: A single-center retrospective review of consecutive cases of FEL in children and adults reported to a national poison center (the Swiss Toxicological Information Center) between 1995 and 2012. Results: 123 cases (83.7% males, mean age 21.9 years) were included. The most frequently reported symptom was cough (50.4%), followed by chest pain (45.5%), and fever (35.8%). Dyspnea was reported by 23.6%. Cough (p = 0.002) and chest pain (p = 0.02) were significantly more prevalent in subjects reporting to have aspirated the fuel compared to those who have swallowed it or who did not perceive poison exposure. A pulmonary infiltrate was detected in 83% of the cases in whom chest X-ray was performed. Overall, 22% were treated with an antibiotic agent for a mean duration of 10.4 days. Corticosteroids were administered in 4.9%. All showed complete recovery irrespective of the therapeutic management. Conclusion: The combination of intense pleuritic chest pain, cough, dyspnea, and fever, or any of these symptoms after ‘fire eating' or erroneous swallowing of a petroleum distillate should alert the clinician to the diagnosis of FEL. Early antibiotic treatment of severe cases seems justified, considering that clinical, laboratory, and radiologic findings of FEL are overlapping with bacterial superinfection.

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