Adult Chemical Pneumonitis Caused by Accidental Kerosene Aspiration: A Case Report

Kerosene aspiration is a recognized cause of chemical pneumonitis, most commonly reported in children, whereas adult cases are rare. We present a case of severe chemical pneumonitis in an elderly patient following accidental kerosene ingestion in an agricultural setting. A 73-year-old male farmer undergoing maintenance dialysis accidentally ingested kerosene that had been stored in a plastic drink bottle during open-field burning. Although he immediately spat it out, he developed progressive dyspnea, fatigue, and vomiting. Chest radiography and computed tomography revealed extensive bilateral pulmonary infiltrates, predominantly in the lower lung fields. The patient was admitted to the intensive care unit for supportive management; mechanical ventilation was not required. Empirical antibiotic therapy was initiated due to concern for secondary infection. Serial imaging demonstrated evolution of the pulmonary infiltrates into multiple cavitary lesions with air-fluid levels, followed by gradual regression of these lesions. Despite a prolonged clinical course and transient pleural effusions, the patient's respiratory status steadily improved. He was transferred to a rehabilitation facility for functional recovery and was discharged without respiratory sequelae. Follow-up chest radiography two months later showed near-complete resolution of pulmonary abnormalities. This case highlights that even minimal kerosene aspiration can result in severe lung injury in adults, including cavitary changes. Despite the severity and prolonged course, favorable outcomes can be achieved with careful supportive management. Increased awareness of the risks associated with improper storage of hazardous substances is essential to prevent accidental ingestion, particularly in agricultural environments.