Fire-Eater’s Lung

Abstract

Fire eater's lung (FEL) is an acute hydrocarbon pneumonitis caused by aspiration or inhalation into airways of liquid hydrocarbons. This disorder is classified into distinct form of chemical toxic pneumonitis. An amateur fire-eater is presented in this work. He accidentally aspirated into airways about 1/3 of glass of grill lighter fluid composed of mixture of liquid hydrocarbons. A few hours after this incident he had severe symptoms like weakness, high temperature, midsternal pleuritic chest pain, myalgia of the back, shortness of breath, and dry cough. Radiologic examination revealed consolidations with well−defined cavitary lesions (pneumatoceles) in lower lobes mainly in the left lower lobe. After one week of this event clinical improvement was observed. The lesions resolved nearly completly during three months. The review of the literature connected with fire-eater's lung is also presented.

Lung on fire: a very severe case of fire-eater’s lung

“…In a review of 123 patients with FEL, the vast majority with mild to moderate disease (mean duration hospitalisation 11 days in 18 patients out of 123), the most frequently symptoms observed included dry cough, chest pain, dyspnoea and fever 2 ; haemoptysis, myalgia, nausea and emesis may also be present. [1][2][3][4] Chest auscultation may reveal crackles, and blood tests show neutrophil leucocytosis and high CRP levels. Radiologic manifestation at 12-24 hours after aspiration show unilateral or bilateral ground glass opacities and consolidation areas that frequently involve the middle lobe or the lower lobes.…”

“…Radiologic manifestation at 12-24 hours after aspiration show unilateral or bilateral ground glass opacities and consolidation areas that frequently involve the middle lobe or the lower lobes. [1][2][3] Possible complications of FEL are pneumatoceles, widespread lung consolidation, superinfections, abscesses, pleural effusion, bronchopleural fistula, pneumothorax and adult respiratory distress syndrome. 2 3 The optimal treatment of FEL has not yet been established, particularly in severe cases.…”

“…2 3 Inhalation of large amounts of hydrocarbons can lead to a severe respiratory distress that requires mechanical ventilation. 3 Surgical resection is usually unwarranted as lipoid pneumonia may regress spontaneously; surgery, however, can be useful in the management of complications.…”

“…Importantly, our case demonstrates that, despite the severe initial presentation, FEL usually has a favourable resolution, and 'restitutio ad integrum' can be obtained between a few weeks and 3 months from injury, 1 4 and that the overall mortality rate is less than 1%. 3 In this respect, recent studies provide evidence that young adults have a great ability to regenerate lung tissue and that lung repair capacity declines with ageing. 5 Finally, our observation demonstrates that in severe FEL a long-term follow-up is necessary, because several complications may occur particularly within the first month of the disease.…”

“…The lipids may remain within the macrophages for a long time but after their lysis are released back into the alveoli. This lipid release may trigger a giant-cell response and lead to fibrosis 1–3…”