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[Exogenous lipid pneumonia with hyperpyrexia: a case report].

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Exogenous lipoid pneumonia (ExLP) can present with severe symptoms like high fever, differing from typical mild cases. This case highlights the varied clinical course and challenges in treating ExLP, even with standard therapies.

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Area of Science:

  • Pulmonology
  • Pathology
  • Medical Case Reports

Background:

  • Lipoid pneumonia (LP) is an uncommon lung disease characterized by intra-alveolar lipids and lipid-laden macrophages.
  • It is classified into exogenous (ExLP) and endogenous (EnLP) forms, with ExLP often linked to inhaling oily substances like mineral oil.
  • ExLP typically presents with mild symptoms and a chronic course, though acute, severe presentations are possible.

Observation:

  • A 77-year-old woman developed acute symptoms, including high fever and elevated white blood cells, after aspirating paraffin oil used for constipation.
  • Chest CT revealed progressive ground-glass opacities and consolidation, unresponsive to broad-spectrum antibiotics.
  • Bronchoalveolar lavage (BAL) showed lipid-laden macrophages (Oil Red O positive), confirming ExLP, despite clear, non-milky BAL fluid.

Findings:

  • The patient's condition was severe, marked by persistent hyperthermia, unlike the usual mild manifestations of ExLP.
  • Standard treatments including corticosteroids and immunoglobulins showed limited efficacy.
  • Whole lung lavage, performed later, led to complications including acute pulmonary edema, and the patient ultimately died.

Implications:

  • This case underscores the diverse clinical spectrum of ExLP, which can range from asymptomatic to life-threatening.
  • It highlights the diagnostic importance of identifying lipid-laden macrophages in BAL fluid, especially when clinical presentation is atypical.
  • The case also points to potential challenges and complications associated with aggressive treatment modalities like whole lung lavage in severe ExLP.