Successful treatment of lipoid pneumonia associated with bowel obstruction by Ascaris lumbricoides

Abstract

Partial bowel obstruction is a serious complication of ascariasis infestation generally treated with mineral oil. This prospective study aimed to evaluate the efficacy of multiple bronchoalveolar lavages (BAL) as a therapeutic strategy for reducing lung inflammation of lipoid pneumonia associated with ascariasis. The study included five children (mean age 25 months) with partial small-bowel obstruction by Ascaris lumbricoides, who underwent diagnostic bronchoalveolar lavage for assessment of refractory pneumonia. Routine biochemical, microbiological and cytological analysis were carried out in the BAL. Protein, lactate dehydrogenase and tumor necrosis factor-alpha (TNF-α) cytokine levels were determined in the serum before and after treatment. At admission, children consistently had respiratory symptoms, altered hematological function, increased immunoglobulin E serum level and peripheral blood eosinophilia. Chest tomography showed consolidation with air bronchogram (4/4), ground-glass infiltration (3/4) and decreased attenuation in the consolidation areas (2/4). Presence of marked pleocytosis with Sudan positive foamy alveolar macrophages, high protein and lactate dehydrogenase levels in the BAL indicated presence of mixed alveolitis. One child with extensive consolidation and air bronchogram in both lungs died before treatment. Multiple bronchoalveolar lavages efficiently removed alveolar oil deposits, restored BAL cellularity, improved clinical symptoms, radiological parameters and further reduced inflammatory reaction evidenced by marked decrease of the inflammatory cytokine, TNF-α. This study presents a therapeutic strategy for management of lung complications caused by mineral oil administration to treat intestinal bowel obstruction associated with ascariasis.

Exogenous lipoid pneumonia. Clinical and radiological manifestations

“…Mineral oil is also used in children for partial small bowel obstruction by Ascaris lumbricoides. 12,13 However, it must be remembered that infants and small children often object vigorously to ingest the oil, resulting in gagging that precipitates aspiration. 14 Different substances called pyrofluids are used by "fireeaters" (performers that "swallow" or "spit" fire).…”

“…14 Whole lung lavage, sometimes used in the treatment of patients with symptomatic alveolar proteinosis, may also be therapeutic in treating LP. 6,13,44 However, in some cases, it seems that lipid phagocytosis by macrophages may impede the removal by bronchial lavage. 59 There are reports of systemic corticosteroids use to slow the inflammatory response.…”