Neumonía lipoidea exógena crónica y sobreinfección por Mycobacterium tuberculosis / Chronic Exogenous Lipoid Pneumonia and Superinfection by Mycobacterium Tuberculosis

Introducción: la neumonía lipoidea exógena es una enfermedad pulmonar inflamatoria poco común, desencadenada por la inhalación o aspiración de material graso de origen animal, vegetal o mineral. El diagnóstico se establece a través de confirmación histo-patológica, por la presencia de macrófagos cargados de lípidos en muestras respirato-rias, asociado a las características clínicas específicas al momento de su presentación.Requiere de un alto nivel de sospecha y una adecuada anamnesis de los antecedentes exposicionales del paciente debido a que muchos casos son subdiagnosticados y trat-ados como neumonía adquirida en la comunidad, lo que retrasa su diagnóstico y mane-jo, sumado a la ausencia de guías disponibles para su tratamiento.Se han reportado pocos casos de sobreinfección por tuberculosis en pacientes con neu-monía lipoidea exógena crónica. Caso clínico: femenino 33 años, con antecedentes de exposición crónica a sustancias desinfectantes de características aceitosas sin protección de vía aérea, con cuadro de tos y dolor torácico. Conclusión: el diagnóstico temprano, asociado a tratamiento de soporte, general-mente conservador, favorece la mejoría clínica y radiológica, y de esta manera dis-minuye la morbimortalidad. (AU)

Introduction: exogenous lipoid pneumonia is a rare inflammatory lung disease, trigge-red by inhalation or aspiration of fatty material of animal, vegetable or mineral origin. The diagnosis is established through histological confirmation by the presence of lipid-laden macrophages in respiratory samples, associated with the specific clinical charac-teristics at the time of presentation. It requires a high level of suspicion and an adequate anamnesis of the patient's expo-sure history, since many cases are underdiagnosed and treated as community-acquired pneumonia, what delays its diagnosis and management, added to the absence of avai-lable guidelines for its treatment. Few cases of tuberculosis superinfection have been reported in patients with exoge-nous lipoid pneumonia.Clinical case: 33-year-old female, with a history of chronic exposure to oily disinfectant substances without airway protection, with symptoms of cough and chest pain.Conclusion: early diagnosis, associated with supportive treatment, generally conser-vative, favors clinical and radiological improvement, thus reducing morbidity and mor-tality. (AU)

Neumonía lipoidea exógena aguda por aspiración accidental de hidrocarburos / Acute exogenous lipoid pneumonia for accidental aspiration of hydrocarbons

La neumonía lipoidea es una enfermedad respiratoria poco conocida que resulta de la acumulación de lípidos de origen endógeno o exógeno a nivel del alveolo pulmonar. Suele ser subdiagnosticada ya que la presentación clínica es inespecífica, por lo que suele confundirse con otras patologías broncopulmonares. Se presentó el caso de un paciente de 18 años antecedentes de aspiración accidental de combustible que seis horas después comenzó con fiebre, hemoptisis, tos y disnea. Se realizó radiografía de tórax donde se observó una neumonía en base derecha que unido al interrogatorio y a la realización de la broncoscopía confirmaron el diagnóstico de neumonía lipoidea. El paciente evolucionó favorablemente con el tratamiento(AU)

Lipoid pneumonia is a little known respiratory disease that results from the accumulation of lipids of endogenous or exogenous origin in the pulmonary alveolus. It is usually underdiagnosed since the clinical presentation is nonspecific, which is why it is often confused with other bronchopulmonary pathologies. We report the case of an 18-year-old patient with a history of accidental fuel aspiration, who ran fever six hours later, together with hemoptysis, cough, and dyspnea. Chest X-rays showed a right base pneumonia. The questioning and the performance of the bronchoscopy confirmed the diagnosis of lipoid pneumonia. The patient evolved favorably with the treatment(AU)

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.

Exogenous lipoid pneumonia presented by acute eosinophilic pneumonia

Exogenous lipoid pneumonia is an uncommon medical condition resulting from aspiration or inhalation of oily material. Generally, lipoid pneumonia has nonspecific clinical and radiological presentations, and may be misdiagnosed as bacterial pneumonia or lung cancer. We describe an unusual case of exogenous lipoid pneumonia accompanied by peripheral blood and pulmonary eosinophilia. A 63-year-old man was admitted with progressively worsening exertional dyspnea and productive cough for 5 days. A chest radiograph showed abnormalities in the lower lobe of the right lung, and a diagnosis of community-acquired pneumonia was made; intravenous antibiotics were administered. However, dyspnea and hypoxia gradually worsened and peripheral blood eosinophilia developed. A bronchoscopy was performed and bronchoalveolar lavage fluid analysis showed markedly increased numbers of eosinophils (40%). Subsequently, a comprehensive review of history revealed that he fell asleep with camellia oil in his mouth for 2 weeks to relieve foreign body sensation of the throat. Sputum and bronchoalveolar lavage fluid cytology showed the presence of lipid-laden macrophages. He was diagnosed with lipoid pneumonia and acute eosinophilic pneumonia. Chest radiograph and symptom were rapidly improved after treatment with intravenous methylprednisolone.

Exogenous lipoid pneumonia induced by long-term usage of compound menthol nasal drops: a case report / 北京大学学报(医学版)

Here we reported a case of exogenous lipoid pneumonia from Peking University Third Hospital. A 62-year-old male presented with chronic cough and expectoration for 8 years, without chest pain, hemoptysis or short of breath. He was an ex-smoker. In his past medical history, the patient reported chronic rhinitis sicca for 20 years. Chest computed tomography (CT) showed patchy ground glass opacities in his bilateral lower lobe. In recent 3 years, his symptoms showed slowly deteriorative changes, as did his chest CT findings. No improvement of the patient's symptoms was observed, although he had been treated with many antibiotics. Then he was referred to our hospital for a detailed investigation for interstitial lung disease. On admission, the physical examination showed no abnormal findings except for inspiratory fine crackles in his bilateral lower lung field on auscultation. The results of the laboratory analysis, including complete blood cell count, biochemistry, arterial blood gas, urinalysis, antinuclear antibody (ANA), antineutrophil cytoplasmic antibody (ANCA) and tumor markers were all within normal ranges. To exclude the possibility of infectious or malignant conditions, bronchoscopy was performed. Secretions from the left lower lobe bronchus were collected for bacterial, fungal and fast-acid cultures, which were all negative. A bronchoalveolar lavage (BAL) was performed in the left lower lobe with a 30% recovery. The total cell count of the BAL fluid was 6.5×104/mL, and the cellularity differential revealed increased neutrophils (20%) and lymphocytes (17%). The cytological examination in the BAL fluid showed no malignant cells. All the clinical data above did not reveal any conclusive information. However, the pathological findings of his transbronchial lung biopsy (TBLB) were highlighted with lipid-laden macrophages engulfed by large vacuoles occupying almost completely the cytoplasm of the cells, which were consistent with those of exogenous lipoid pneumonia. Given these findings, it emerged that the patient was taking twice daily inhalations of a compound menthol nasal drops (essential oil of camphor, menthol and liquid paraffin) for his chronic rhinitis sicca for at least 10 years. Then he discontinued oil nasal sprays and showed gradual improvement 3 months later without intensive treatment. The presenting case report emphasizes the fact that chronic inhalation of nasal sprays and decongestants containing mineral oils was a cause of exogenous lipoid pneumonia, and clinicians should bear it in mind.

Exogenous lipid pneumonia with hyperpyrexia: a case report / 北京大学学报(医学版)

Lipoid pneumonia (LP) is an uncommon form of pneumonia that is characterized by the presence of intra-alveolar lipid and lipid-laden macrophages on microscopy. It categorized as exogenous lipoid pneumonia (ExLP) and endogenous lipoid pneumonia (EnLP). Exogenous lipoid pneumonia caused by inhalation of liposuction substances (animal fat, vegetable oil, or mineral oil), mostly, in adult cases, they were medicines for constipation or rhinopharyngitis. Most of these patients showed mild clinical manifestations, and chronic medical condition. There were reports of lipoid pneumonia being successfully treated with corticosteroids, immunoglobulins and whole lung lavage. We report a case of exogenous lipoid pneumonia characterized by high fever and acute medical condition. A 77-year-old woman with hypertension and diabetes mellitus, accepted paraffin oil treatment for "incomplete intestinal obstruction", then, an accident of aspiration happened, as she went through the history of coughing while eating, followed by persistent hyperthermia and increases of white blood cells (WBC). Chest CT showed progressive ground-glass opacities, accompanied with fusion of consolidation, her sputum etiological examination was negative, and the therapy of broad-spectrum antibiotic was invalid. The patient was subjected to bronchofibroscopy with bronchoalveolar lavage (BAL). The bronchoalveolar lavage fluid (BALF) appeared colorless and transparent, and did not show a milky appearence. Total cell count of the BALF was 2.0×109 cell/mL, including 7.2% macrophages and 92.8% neutrophils. Cultures of the BALF were negative for bacterial, fungal, and mycobacterial pathogens. The BALF cytologic findings showed vacuolated lipid-laden macrophages (Oil Red O staining). These findings revealed exogenous lipoid pneumonia. There were reports of lipoid pneumonia being successfully treated with corticosteroids, immunoglobulins, and whole-lung lavage. So this patient was treated with methylprednisolone 120 mg/d for 3 days and 80 mg/d for 6 days, at the same time, immunoglobulins was given to infusion, but the daily peak temperature of the patients fluctuated between 38 and 39 degrees. Then, whole lung lavage was performed 28 days after admission. Unfortunately, acute pulmonary edema occurred during the operation, as the tracheal intubation problems, and 6 days later, the patient died at last. The clinical manifestations of exogenous lipid pneumonia vary greatly, from asymptomatic to life-threatening symptoms, and as febrile low fever is the main manifestation, but hyperthermia may also be the remarkable presentation.

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.

Neumonía lipoidea tras aspiración accidental de vaselina / Lipoid pneumonia after accidental aspiration of vaseline

La neumonía lipoidea es una patología pulmonar poco conocida que resulta de la acumulación de lípidos de origen endógenos o exógenos a nivel alveolar pulmonar. Suele ser subdiagnosticada dada que la presentación clínica es inespecífica, por lo que suele confundirse con otras patologías broncopulmonares, muchas veces no llegándose al diagnóstico preciso de esta. Dentro de los datos anamnesticos el antecedente, ya sea de uso reciente o de larga data, de la ingesta y/o inhalación accidental o voluntaria de alguna sustancia que contenga algún componente lipídico en su base es primordial. Pacientes de edades extremas suelen ser los más afectados y en quienes debemos tener la sospecha diagnóstica. Su diagnóstico es complejo requiriendo historia clínica, imágenes que apoyen un compromiso pulmonar (de preferencia tomografía computada) e idealmente la detección intraalveolar de lípidos y macrófagos cargados de éstos en el lavado broncopulmonar. Actualmente, no existe consenso sobre el manejo específico de esta patología. Lo importante es identificar la causa y descontinuar su uso. En neumonía lipoidea de causa exógena se recomienda manejo de soporte según sea la presentación clínica del paciente.

Lipoid pneumonia (LN) is an unknown lung disease due to lipid accumulation, of endogenous or exogenous origin, at the pulmonary alveolar level. Often it is underdiagnosed because of its nonespecific presentation whose differential diagnosis are other bronchopulmonary diseases. Anamnestic data, either recent or long-standing use of the intake and / or accidental or deliberate inhalationof any substance containing a lipid component as its base is relevant information. Extreme age groups are the most affected, and in whom wemust suspect LN diagnosis. The diagnosis of LN is complex and requires a complete medical history, images that support lung involvement (preferably computed tomography), and ideally intraalveolar detection of lipid-ladenmacrophages in the bronchoalveolar lavage. Currently, there is no consensus on the specific management of this disease. It is important to identify the cause and discontinue its exposure. Whatever the varity of the clinical presentation, support magement is recommended to treat LN.

Neumonía lipoidea por exposición laboral / Lipoid pneumonia due to occupational exposure

La neumonía lipoidea es una condición poco común que resulta de la presencia de lípidos en el interior del espacio alveolar. Según la fuente de los lípidos se ha clasificado en endógena y exógena y esta a su vez según la presentación en aguda y crónica. La neumonía lipoidea exógena se produce por aspiración o inhalación de sustancias oleosas, suele presentarse en pacientes con predisposición a broncoaspiración por alteraciones anatómicas o neurológicas, sin embargo se puede presentar en pacientes sanos que están expuestos a este tipo de sustancias y suele ser en el medio laboral. La fisiopatología es secundaria a una respuesta de cuerpo extraño que termina en fibrosis pulmonar. Los síntomas que produce al igual que manifestaciones al examen físico son inespecíficos y los hallazgos en los exámenes de laboratorio y gabinete también lo son, esto hace que sea una patología poco diagnosticada; sin embargo, haciendo una buena historia clínica e historia laboral se puede sospechar su diagnóstico en el caso de los médicos tratantes o establecer una relación de causalidad en el caso del médico forense. Presentación de caso: Se expone el caso de masculino de 34 años de edad referido por un caso de riesgo laboral, el mismo sin antecedentes patológicos conocidos, quien estuvo expuesto al humo del vehículo que conducía, posteriormente inicia con síntomas respiratorios inespecíficos y finalmente es diagnosticado con neumonía lipoidea.

The lipoid pneumonia is an uncommon condition that results from the presence of lipids within the alveolar space. According to the source of lipids has been classified into endogenous and exogenous, and this in turn according to the presentation in acute and chronic. Exogenous lipoid pneumonia is caused by inhalation or aspiration of oily substances, usually seen in patients predisposed to aspiration for anatomical or neurological disorders, but also can occur in healthy patients who are exposed to these substances and are usually cases of occupational exposure. The pathophysiology is secondary to a foreign body response that ends in pulmonary fibrosis. Symptoms and physical examinations findings are nonspecific as well as laboratory and cabinet tests, this makes it a disease underdiagnosed; however, doing a good history and labor history may suspect the diagnosis in the case of treating physicians or establish a causal link if the case of the forensic medical. Case presentation: Male 34 years of age are exposed, referred by a case of occupational risk, the same with no known medical history, who was exposed to the vehicle driven smoke then begins with nonspecific respiratory symptoms and finally is diagnosed with lipoid pneumonia.

Clinical characteristics of lipid aspiration pneumonia in 16 children / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate clinical characteristics and changes of pulmonary imaging of mineral oil aspiration pneumonia in children.</p><p><b>METHOD</b>The clinical features, CT findings, and effects of corticosteroid therapy were analyzed in 16 children with mineral oil aspiration pneumonia, who were hospitalized in our hospital from January 2003 to July 2013.</p><p><b>RESULT</b>All patients with mineral oil aspiration pneumonia had a history of mineral oil administration.Four patients had no clinical manifestations. Ten cases presented fever, and 8 of the 10 patients had fever in 4-8 h after taking mineral oil, and the temperature was between 39-40 °C. There were wheezing in 2 cases, shortness of breath in 6 cases, cyanosis in 1 case, dyspnea in 3 cases, and moaning in 2 cases, chest pain in 1 case, headache and abnormal EEG in 1 case.Six patients had rales in lungs. Peripheral blood white cells increased in 10 cases, and C- reactive protein elevated in 7 patients. Chest CT examination showed abnormal findings in 6 children, and the earliest CT was performed within 2 h after the accident. The rest 10 children got chest X-ray, and 9 of 10 children had abnormal findings. The earliest X-ray was done within 3 h after the accident. And the remaining 1 of 10 children showed no significant changes in the first chest X-ray 2-3 h after the accident until 3 days. All of the patients received corticosteroid and antibiotic treatments, 4 cases underwent bronchoalveolar lavage, 3 patients were given albumin, 6 cases received intravenous immunoglobulin. Three cases delayed in treatment with hormone because of misdiagnosis, and 2 of them had clearly secondary infections. Twelve patients recovered completely from oil aspiration pneumonia after 8 days to 5.5 months.</p><p><b>CONCLUSION</b>Oil aspiration pneumonia in children occurs in almost all cases after mineral oil aspiration. Pulmonary opacities can be found by chest CT in most patients within 24 hours after mineral oil aspiration. Corticosteroids therapy was effective for patients with exogenous lipid pneumonia, which may inhibit the inflammatory response and possible pulmonary fibrosis.</p>

Endogenous lipoid pneumonia associated with Legionella pneumophila serogroup 1

Endogenous lipoid pneumonia is an uncommon condition. This is a report of a 29-year-old woman diagnosed with endogenous lipoid pneumonia associated with Legionella pneumophila serogroup 1 infection. The patient's endogenous lipoid pneumonia resolved completely after treatment for Legionella pneumophila infection. This suggests that early diagnosis and aggressive treatment of the underlying infection may prevent any long-term sequelae of lipoid pneumonia.

Pneumonia lipídica em um lactente / Lipid pneumonia in an infant

Lactente de seis meses apresentava pneumonia refratária a diferentes antimicrobianos previamente utilizados. Houve melhora clínica, mas havia persistência de lesão pulmonar no radiograma de tórax. Obteve-se a informação do uso prévio de óleo mineral devido à constipação eventual. Realizou-se broncoscopia, lavado bronquíolo-alveolar e exame anatomopatológico definindo o diagnóstico como Pneumonia Lipídica. A pneumonia lipídica deverá sempre ser considerada no diagnóstico diferencial de pneumonia de evolução prolongada sem resposta ao tratamento com antimicrobianos para germes comuns e naquelescasos suspeitos de tuberculose. É importante que os pais sejam orientados sobre o uso de óleo mineral em lactentes e crianças previamente constipadas, devido ao risco de aspiração e posterior pneumonia.

A six-month old infant had pneumonia and a resistance to previously-used antimicrobials. There was clinical improvement, but a radiogram discovered a persistent pulmonary lesion in the chest. We discovered a previous use of mineral oil to combat a bout of suspected constipation. This revelation led us to performing a bronchoscopy, a bronchoalveolar lavage-alveolar procedure,and other pathological examinations, all of which led us to conclude that the condition was a form of lipid pneumonia. Thus, lipid pneumonia should always be considered in the differential diagnosis of prolonged evolving pneumonia when not responding to treatment with antimicrobials for common germs. It should also be considered in those cases of suspected tuberculosis. Because of the risk of aspiration and subsequent pneumonia, it is important that parents with infants and children be instructed on the use of mineral oil when addressingconstipation in their offspring.

Aspectos tomográficos e anatomopatológicos do padrão de pavimentação em mosaico / Tomographic and pathological findings of crazy-paving pattern

OBJETIVO: Relatar os aspectos na tomografia computadorizada de alta resolução de diversas doenças que cursam com o padrão tomográfico de "pavimentação em mosaico". MATERIAIS E MÉTODOS: Foram estudados sete pacientes, com diagnósticos de proteinose alveolar, carcinoma bronquíolo-alveolar, pneumonia lipídica e pneumocistose, e é discutida a correlação dos aspectos tomográficos com os achados anatomopatológicos. RESULTADOS: Nos casos de pneumocistose, os espaços alveolares estavam cheios de material espumoso, no qual eram encontrados parasitas de permeio a surfactante, fibrina e restos celulares. Nos casos de carcinoma bronquíolo-alveolar, os septos estavam espessados por fibrose ou por linfangite associada, com células tumorais revestindo internamente as paredes alveolares, e produção de muco. No paciente com proteinose alveolar foram observados septos espessados por edema, com enchimento alveolar determinado por material lipoproteico. No paciente com aspiração de óleo mineral, os achados histopatológicos foram de espessamento dos septos alveolares determinado por proliferação celular, observando-se vacúolos de gordura no interior dos septos alveolares. CONCLUSÃO: O padrão de pavimentação em mosaico oferece um amplo diagnóstico diferencial, necessitando ser avaliado em conjunto com os dados clínicos.

OBJECTIVE: To describe high-resolution computed tomography findings in several diseases that run their course with the "crazy-paving" pattern. MATERIALS AND METHODS: The present study has evaluated seven patients with diagnoses of alveolar proteinosis, bronchioloalveolar carcinoma, lipoid pneumonia and pneumocystosis, correlating tomographic and pathological findings. RESULTS: In the cases of pneumocystosis, the alveolar spaces were filled with foamy material where parasitic organisms intermingled with surfactants, fibrin and cell debris were observed. In the cases of bronchioloalveolar carcinoma, the septa were thickened by associated fibrosis or lymphangitis, with the alveolar walls internally lined with tumor cells, and production of mucus. In the patient with alveolar proteinosis, the septa were thickened by edema, with alveolar filling determined by lipoprotein. In the patient with mineral oil aspiration, the histopathological findings included alveolar septa thickening caused by cell proliferation, with presence of fat vacuoles in alveolar septa. CONCLUSION: The crazy-paving pattern offers a wide range of differential diagnoses and must be evaluated in conjunction with clinical findings.

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.

A Case of Lipid Pneumonia by Green Perilla Oil / 결핵및호흡기질환

Exogenous lipid pneumonia is a rare disease resulting from the aspiration or inhalation of vegetable, animal, or mineral oils. In Korea, the most frequently implicated agent is squalen, which can be obtained from shark liver oil. Lipid pneumonia by aspiration of the vegetable oil is very rare. We experienced a 77-year-old man with a history of ingestion of green perilla oil. His clinical course was favorable; after exposure to the oil was stopped, the patient's symptoms improved.

A Case of Lipoid Pneumonia Associated with Silicon Oil Injection into Breast / 결핵및호흡기질환

Exogenous lipoid pneumonia occurs rarely in healthy people. In most cases, exogenous lipoid pneumonia is usually caused by aspiration of mineral, vegetable, or animal oil. We report the case of 42-year-old woman, who have experienced lipoid pneumonia after silicon injection into her breast for cosmetic purposes. The patient experienced fever, dyspnea, sputum, and hemoptysis after silicon injection into her breast. Chest computed tomography demonstrated non-segmental distribution of bilateral consolidation in both lung fields. A transbronchial lung biopsy specimen shows foamy microphages in alveolar spaces. Papanicolaous staining of bronchoalveolar lavage fluid showed abundant foamy marcrophages and many neutrophils. With these results, we confirmed lipoid pneumonia was associated with silicon oil injection into breast.