[Acute exogenous lipoid pneumonia in "fire-eaters". Description of two cases]

Exogenous lipoid pneumonia is a rare disease that has traditionally been considered a chronic condition secondary to continued aspiration or inhalation of fatty substances. An acute form may sometimes appear after a single and massive aspiration of lipid material, being a characteristic accident of street artists or "fire-eaters" that may generate acute respiratory failure. In this paper, we present clinical and radiological signs and outcome of two cases of lipoid pneumonia in "fire-eaters". A few hours after exposure patients may develop fever, cough, chest pain, hemoptysis, pulmonary infiltrates or hypoxemia. While diagnosis of chronic forms may require invasive procedures, recent exposure to fatty substances is a clue for clinical diagnosis in acute forms. Acute forms usually have a good outcome but cases evolving to cavitary pneumonia have been described. Some patients can present with acute respiratory distress syndrome and death. Treatment is based on general supportive measures.