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.