Idiopathic Lipoid Pneumonia: An incidental finding in autopsy specimen

Phosphorus is a nonmetallic irritant used in various sectors like rodenticide, firecracker industries, match industries, and fertilizers. Phosphorus poisoning is responsible for deaths among children and adults. Accidental yellow phosphorus poisoning is frequently reported in children, whereas suicidal consumption is not uncommon amongst adults. Herein, we present the case of a 30-year-old female patient who ingested Ratol paste containing yellow phosphorus in an attempt to commit suicide. Her initial chief complaints were nausea, vomiting along with loose motion during hospitalization, followed by a symptomless phase with stable vitals on the 2nd day, and managed conservatively. She took discharge against the medical advice. Later on, she was readmitted in the same hospital, after two days, complaining of generalized weakness, bodily pain, drowsiness, loss of appetite, and breathing difficulties. She developed severe complications due to the intoxication and died. An autopsy was performed. The histopathological and the toxicological examination were carried out. We found characteristic features in different organs due to yellow phosphorus toxicity. We concluded the cause of death as hepatic encephalopathy and multi-organ dysfunction syndrome caused by the yellow phosphorus poisoning.

Neumonia lipoidea: causa infrecuente de infiltrados pulmonares / Lipoid pneumonia: an infrequent cause of pulmonary infiltrates

La presencia de infiltrados pulmonares es un hallazgo frecuente que incluye un amplio diagnóstico diferencial basado en muchas ocasiones en la historia clínica. Entre ellas, la neumonía lipoidea exógena representa una entidad poco frecuente y es preciso un elevado índice de sospecha para alcanzar su diagnóstico y evitar su progresión. En estos casos, un contexto clínico adecuado y una TC con opacidades y áreas de baja densidad pueden ser altamente sugestivos de la enfermedad. Se presenta un caso de neumonía lipoidea exógena secundaria a la utilización continuada de sustancias oleosas intranasal, que debido a los antecedentes del paciente y a las posibilidades diagnósticas tras los hallazgos de la TC, precisó confirmación histológica.

The presence of pulmonary infiltrates is a frequent finding that includes a large differential diagnosis based on many occasions in the clinical history. Among them, exogenous lipoid pneumonia represents a rare entity and a high index of suspicion is necessary to reach its diagnosis and prevent its progression. In these cases, an adequate clinical context and a CT with opacities and low density areas are highly suggestive of the disease. We present a case of exogenous lipoid pneumonia secondary to the continued use of oily substances at the nasal level, due to his antecedents and the diagnostic possibilities after the CT findings, histological confirmation was required.

Neumonía lipoidea exógena: Una causa inhabitual de nódulos pulmonares: casos clínicos / Exogenous lipoid pneumonia: report of three cases

Lipoid pneumonia is an unusual cause of aspiration pneumonia with diverse radiologic manifestations. One of these are pulmonary nodules in which the main differential diagnosis is pulmonary carcinoma. We report an 85 years old male, an 85 years old female and a 34 years old male in whom percutaneous biopsies of suspicious nodules were compatible with lipoid pneumonia.

Pneumonia lipoide secundária ao uso prolongado de óleo de prímula / Lipoid pneumonia secondary to long-term use of evening primrose oil

A pneumonia lipoide é uma doença pouco diagnosticada, causada pela aspiração de partículas oleosas para dentro dos pulmões. Os casos relatados têm sido relacionados ao uso de óleo mineral como laxativo, mas outras soluções oleosas também podem causar a doença. Relatamos o caso de uma paciente de 50 anos com queixa de tosse produtiva, sendo diagnosticada inicialmente com hiper-reatividade brônquica e doença do refluxo gastroesofágico (DRGE). A paciente foi submetida a tratamento para DRGE. Devido à persistência da tosse, a paciente foi submetida a TC de tórax, fibrobroncoscopia e biópsia pulmonar a céu aberto, sendo diagnosticada com pneumonia lipoide. A paciente foi questionada quanto ao uso de substâncias oleosas, relatando o uso crônico de óleo de prímula. Com a suspensão do uso da substância e a continuidade do tratamento para DRGE, houve melhora do quadro.

Lipoid pneumonia is an underdiagnosed disease that is caused by the aspiration of lipid particles into the lungs. Although most of the reported cases have been associated with the use of mineral oil as a laxative, other lipid substances can also cause the disease. We report the case of a 50-year-old female patient with a complaint of productive cough who was initially diagnosed with bronchial hyperresponsiveness and gastroesophageal reflux disease (GERD). The patient was treated for GERD. Because the productive cough persisted, the patient underwent chest CT, fiberoptic bronchoscopy, and open lung biopsy. She was diagnosed with lipoid pneumonia. The patient was questioned regarding the use of lipid substances, and she reported the chronic use of evening primrose oil. After the discontinuation of the substance and the maintenance of GERD treatment, her condition improved.

Lipoid pneumonia: An uncommon entity.

Lipoid pneumonia is a rare form of pneumonia caused by inhalation or aspiration of fat-containing substances like petroleum jelly, mineral oils, certain laxatives, etc. It usually presents as an insidious onset, chronic respiratory illness simulating interstitial lung diseases. Rarely, it may present as an acute respiratory illness, especially when the exposure to fatty substance(s) is massive. Radiological findings are diverse and can mimic many other diseases including carcinoma, acute or chronic pneumonia, ARDS, or a localized granuloma. Pathologically it is a chronic foreign body reaction characterized by lipid-laden macrophages. Diagnosis of this disease is often missed as it is usually not considered in the differential diagnoses of community-acquired pneumonia; it requires a high degree of suspicion. In suspected cases, diagnosis may be confirmed by demonstrating the presence of lipid-laden macrophages in sputum, bronchoalveolar lavage fluid, or fine needle aspiration cytology/biopsy from the lung lesion. Treatment of this illness is poorly defined and constitutes supportive therapy, repeated bronchoalveolar lavage, and corticosteroids.

Cod liver oil and liquid paraffin oil induced exogenous lipoid pneumonia in albino rats

This work was carried out on 30 adult albino rats of both sexes, divided into 3 numerically equal groups, 10 animals per each. The study aimed to highlighten the pathological features of cod liver oil and liquid paraffin induced exogenous lipoid pneumonia and increase the awareness of pediatricians and physicians about it to be kept in consideration in the differential diagnosis of various lung conditions, especially if there is history of chronic constipation and chronic intake of oil based laxatives. Cod liver oil group [Group II] received 0.5 ml/kg/day oral cod liver oil and liquid paraffin group [Group III] received 0.66 ml/kg/day oral liquid paraffin in a single daily dose for 12 successive weeks. Pathological specimens were taken from both lungs and examined, by hematoxylin and eosin, wilder silver, orcein and Prussian blue stains. Results revealed extensive pulmonary parenchymal damage and disturbed lung architecture in the form of consolidation, granulomatous formation, fibrosis, lymphocytic and foam cells infiltration. Group II showed more extensive and diffuse consolidation while Group III showed more extensive fibrosis and more abundant granulomatous masses

Neumonía lipoidea exógena asociada a síndrome hemafagocítico / Exogenous lipoid pneumonia associated with hemophagocytic syndrome

La neumonía lipoidea exógena(NLE)se produce por inhalación o aspiración de sustancias oleosas que general una respuesta inflamatoria fibrosante.Es más frecuente durante la administración de aceite mineral por constipación crónica.Presentamos el caso de una niña de veinte meses de edad con pancitopenia que requirió transfusiones,episodios de broncoespamo con bronquitis aguda y hepatomegalia con ictericia.Se descartó hemolísis y enfermedad de Wilson,Un aspirado de médula ósea(MO)mostró hemofagocitosis.En las biopsias de MO e hígado se reconocieron histiocitos de citoplasma amplio,univacuolados o multivacuolados, con siderosis y hemofagocitosis,Se efectuó el diagnóstico de síndrome hemofagocítico(SHF)La paciente no mejoró y falleció al año,días después de una esplenectomía.La necropsia mostró una neumonía lipoidea con fibrosis intersticial e inflamación.En MO se vio extensa histiocitosis y células hemopoyéticas en el sector marginal.El análisis químico del pulmón y MO reveló la presencia de hidrocarburos lineales de 19-20 carbonos asimilables a aceite mineral(vaselina)Interpretamos que la paciente padeció una NLE crónica con daño pulmonar severo.La sustancia exógena desencadenó la activación macrofágica con SHF y pancitopenia.Esta se compensaba con hemopoyesis extramedular y transfusiones.La esplenectomía agravó la anemia y desencadenó el deceso,No hemos hallado referencia de la combinación NLE y SHF

Lymphosarcoma in a brown bear (Ursus arctos)

An example of lymphoblastic lymphosarcoma was found in a 7-year-old male brown bear (Ursus arctos) that died after having a 7-month history of depression, anorexia and watery diarrhea. Grossly the mesenteric lymph nodes were enlarged to approximately 4 to 6 times their normal size and histologically diagnosed as lymphoblastic lymphosarcoma. The small intestinal mucosa was corrugated and had severe mural thickening due to infiltrated neoplastic cells. Hepatic metastasis was also noted. This is the first reported case of lymphosarcoma in Ursidae in Korea. As an incidental finding, endogenous lipid pneumonia was noted in the lung.