Clinical, radiological and therapeutic features of exogenous lipoid pneumonia

##plugins.themes.academic_pro.article.sidebar##

Published Feb 1, 2025
https://doi.org/10.62438/tunismed.v103i2.5261
Download
pdf
Vol. 103 No. 2 (2025): Tunis Med Feb 2025

##plugins.themes.academic_pro.article.main##

Najla Bahloul
Pneumology and Allergology Department, Hédi Chaker Hospital, Sfax. Faculty of Medicine of Sfax, University of Sfax, Tunisia
Mariem Ayadi
Pneumology and Allergology Department, Hédi Chaker Hospital, Sfax. Faculty of Medicine of Sfax, University of Sfax, Tunisia
Rahma Gargouri
Pneumology and Allergology Department, Hédi Chaker Hospital, Sfax. Faculty of Medicine of Sfax, University of Sfax, Tunisia
Siwar Bahri
Pneumology and Allergology Department, Hédi Chaker Hospital, Sfax. Faculty of Medicine of Sfax, University of Sfax, Tunisia
Nadia Moussa
Pneumology and Allergology Department, Hédi Chaker Hospital, Sfax. Faculty of Medicine of Sfax, University of Sfax, Tunisia
Sameh Msaad
Pneumology and Allergology Department, Hédi Chaker Hospital, Sfax. Faculty of Medicine of Sfax, University of Sfax, Tunisia
Samy Kammoun
Pneumology and Allergology Department, Hédi Chaker Hospital, Sfax. Faculty of Medicine of Sfax, University of Sfax, Tunisia

Abstract

Introduction: Lipoid pneumonia is a rare disease affecting adults’ which frequency increases with age. Exogenous lipoid pneumonia results from the penetration, usually by inhalation, of oily substances into the pulmonary parenchyma.


Aim: To study the clinical and radiological features of exogenous lipoid pneumonia and to define therapeutic strategies.


Methods: We performed a monocentric, retrospective study of patients followed in the Pneumology Department of the Hedi Chaker Hospital in Sfax between 2004 and 2023. The diagnosis of exogenous lipoid pneumonia was confirmed by bronchoalveolar lavage with positive Oil Red O staining or by biopsy with anatomopathological examination showing lipid-laden foamy histiocytes.


Results: During this period, we collected nine patients with an average age of 46. Dyspnea and cough were the most frequent symptoms. Chest computed tomography revealed ground-glass opacity in five cases, parenchymal condensations in three cases and crazy paving in three cases. The frequent risk factors were occupational exposure to a lipid in five cases and consumption of a lipid product in four cases.


In terms of treatment, four patients underwent occupational reclassification and a declaration of occupational disease. Systemic corticotherapy was indicated in six patients.


Conclusion: Exogenous lipoid pneumonia is a rare entity. This study highlights the difficulty of making a diagnosis, due to misleading clinico-radiological presentation in the absence of exposure.

Keywords:

Exogenous lipoid pneumonia, Aspiration, Bronchoalveolar lavage

##plugins.themes.academic_pro.article.details##

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

  1. Cozzi D, Bindi A, Cavigli E, Grosso AM, Luvarà S, Morelli N, et al. Exogenous lipoid pneumonia: when radiologist makes the difference. Radiol med. 2021;126(1):22-8.
  2. Betancourt SL, Martinez-Jimenez S, Rossi SE, Truong MT, Carrillo J, Erasmus JJ. Lipoid Pneumonia: Spectrum of Clinical and Radiologic Manifestations. American Journal of Roentgenology. 2010;194(1):103-9.
  3. Rea G, Perna F, Calabrese G, Molino A, Valente T, Vatrella A. Exogenous lipoid pneumonia (ELP): when radiologist makes the difference. Transl Med UniSa. 2016;14:64-8.
  4. Marchiori E, Zanetti G, Mano CM, Hochhegger B. Exogenous lipoid pneumonia. Clinical and radiological manifestations. Respiratory Medicine. 2011;105(5):659-66.
  5. Basset Léobon C, Lacoste-Collin L, Aziza J, Bes JC, Jozan S, Courtade-Saïdi M. Cut-off values and significance of Oil Red O-positive cells in bronchoalveolar lavage fluid. Cytopathology. 2010;21(4):245-50.
  6. Wang Y, Goulart RA, Pantanowitz L. Oil red O staining in cytopathology. Diagnostic Cytopathology. 2011;39(4):272-3.
  7. Jeelani HM, Sheikh MM, Sheikh B, Mahboob H, Bharat A. Exogenous Lipoid Pneumonia Complicated by Mineral Oil Aspiration in a Patient With Chronic Constipation: A Case Report and Review. Cureus. 2020;12(7):e9294
  8. Osman GA, Ricci A, Terzo F, Falasca C, Giovagnoli MR, Bruno P, et al. Exogenous lipoid pneumonia induced by nasal decongestant. ClinRespir J. 2018;12(2):524-31.
  9. Maddock SD, Cirulis MM, Callahan SJ, Keenan LM, Pirozzi CS, Raman SM, et al. Pulmonary Lipid-Laden Macrophages and Vaping. N Engl J Med. 2019;381(15):1488-9.
  10. Nielsen MH, Madsen LB, Bendstrup E. Exogenous lipoid pneumonia due to silent aspiration following surgery and radiotherapy for cancer of the tongue. Respir Med Case Rep. 2022;40:101767.
  11. Pielaszkiewicz-Wydra M, Homola-Piekarska B, Szcześniak E, Ciołek-Zdun M, Fall A. Exogenous lipoid pneumonia – a case report of a fire-eater. Pol J Radiol. 2012;77(4):60-4.
  12. Wong CF, Yan SW, Wong WM, Ho RSL. Exogenous lipoid pneumonia associated with oil pulling: Report of two cases. Monaldi Arch Chest Dis. 2018;88(3):922.
  13. Rajagopala S, Selvam N. An unusual cause of respiratory distress. J Postgrad Med. 2019;65(1):38-40.
  14. Samhouri BF, Tandon YK, Hartman TE, Harada Y, Sekiguchi H, Yi ES, et al. Presenting Clinicoradiologic Features, Causes, and Clinical Course of Exogenous Lipoid Pneumonia in Adults. Chest. 2021;160(2):624-32.
  15. Hadda V, Khilnani GC. Lipoid pneumonia: an overview. Expert Review of Respiratory Medicine. 2010;4(6):799-807.
  16. Acharya V, Dsouza NV, Sreeram S, Rai SPV, Achappa B. Shine like gold and sparkle like glitter: Three cases of lipoid pneumonia. Respiratory Medicine Case Reports. 2021;33:101380.
  17. Aliaga F, Chernilo S, Fernández C, Valenzuela H, Rodríguez JC, Aliaga F, et al. Exogenous lipoid pneumonia. Report of three cases. Revistamédica de Chile. 2017;145(11):1495-9.
  18. Gondouin A, Manzoni Ph, Ranfaing E, Brun J, Cadranel J, Sadoun D, et al. Exogenous lipid pneumonia: a retrospective multicentre study of 44 cases in France. European Respiratory Journal. 1996; 9(7):1463-9.
  19. Han C, Liu L, Du S, Mei J, Huang L, Chen M, et al. Investigation of rare chronic lipoid pneumonia associated with occupational exposure to paraffin aerosol. J Occup Health. 2016;58(5):482-8.
  20. Doubková M, Doubek M, Moulis M, SkſiĿková J. Exogenous lipoid pneumonia caused by chronic improper use of baby body oil in adult patient. Revista Portuguesa de Pneumologia. 2013;19(5):233-6.
  21. Nakashima S, Ishimatsu Y, Hara S, Kitaichi M, Kohno S. Exogenous Lipoid Pneumonia Successfully Treated With Bronchoscopic Segmental Lavage Therapy. Respir Care. 2015; 60(1):e1-5.
  22. Ohwada A, Yoshioka Y, Shimanuki Y, Mitani K, Kumasaka T, Dambara T, et al. Exogenous Lipoid Pneumonia Following Ingestion of Liquid Paraffin. Intern Med. 2002; 41(6):483-6.
  23. Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Stratégies d’interprétation des explorations fonctionnelles respiratoires. Revue des Maladies Respiratoires. 2007;24(3):83-108.
  24. Marchiori E, Zanetti G, Mano CM, Irion KL, Daltro PA, Hochhegger B. Lipoid Pneumonia in 53 Patients After Aspiration of Mineral Oil: Comparison of High-Resolution Computed Tomography Findings in Adults and Children. Journal of Computer Assisted Tomography. 2010;34(1):9-12.
  25. Choi HK, Park CM, Goo JM, Lee HJ. Pulmonary alveolar proteinosis versus exogenous lipoid pneumonia showing crazy-paving pattern: Comparison of their clinical features and high-resolution CT findings. ActaRadiol. 2010;51(4):407-12.
  26. Harris K, Chalhoub M, Maroun R, Abi-Fadel F, Zhao F. Lipoid pneumonia: A challenging diagnosis. Heart & Lung. 2011;40(6):580-4.
  27. Ukkola-Pons E, Weber-Donat G, Teriitehau C, Calcina P, Baccialone J, Vaylet F, et al. Imagerie de la pneumopathiehuileuse. Feuillets de Radiologie. 2010;50(1):3-9.
  28. Guo M, Liu J, Jiang B. Exogenous lipid pneumonia in old people caused by aspiration: Two case reports and literature review. Respir Med Case Rep. 2019;27:100850.
  29. Khilnani G, Hadda V. Lipoid pneumonia: An uncommon entity. Indian J Med Sci. 2009;63(10):474.
  30. Rana D, Kaushik N, Sadhu S, Kalra R, Sen R. Idiopathic Lipoid Pneumonia: An incidental finding in autopsy specimen. Autops Case Rep. 2020;10(1):e2020143
  31. Gaerte SC, Meyer CA, Winer-Muram HT, Tarver RD, Conces DJ. Fat-containing Lesions of the Chest. RadioGraphics. 2002; 22(suppl_1):S61-78.
  32. da Costa FM, Cerezoli MT, Medeiros AK, Magalhães MAF, Castro SN. Small samples, big problems: lipoid pneumonia mimicking lung adenocarcinoma. J Bras Pneumol. 2023; 49(3):e20230147.
  33. Jouneau S, Kerjouan M, Briens E, Lenormand JP, Meunier C, Letheulle J, et al. La protéinose alvéolaire pulmonaire. Revue des Maladies Respiratoires. 2014;31(10):975-91.
  34. Park S, Park JE, Lee J. A case of lipoid pneumonia associated with occupational exposure to solvents in a dry-cleaning worker. Respirology Case Reports. 2021;9(6):e00762.
  35. Alzghoul BN, Innabi A, Mukhtar F, Jantz MA. Rapid Resolution of Severe Vaping-induced Acute Lipoid Pneumonia after Corticosteroid Treatment. Am J RespirCrit Care Med. 2020;202(2):e32-3.
  36. Lococo F, Cesario A, Porziella V, Mulè A, Petrone G, Margaritora S, et al. Idiopathic lipoid pneumonia successfully treated with prednisolone. Heart & Lung. 2012;41(2):184-7.
  37. Shang L, Gu X, Du S, Wang Y, Cao B, Wang C, et al. The efficacy and safety of therapeutic lung lavage for exogenous lipoid pneumonia: A systematic review. Clin Respir J. 2021; 15(2):134-46.
  38. Chardin D, Nivaggioni G, Viau P, Butori C, Padovani B, Grangeaon C, et al. False positive 18FDG PET-CT results due to exogenous lipoid pneumonia secondary to oily drug inhalation. Medicine (Baltimore). 2017; 96(22):e6889.