Wu X J, Li M, Zhan Q Y
Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2018 Oct 18;50(5):921-923.
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 2.0×10 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.
脂质性肺炎（LP）是一种不常见的肺炎形式，显微镜检查显示其特征为肺泡内存在脂质和充满脂质的巨噬细胞。它可分为外源性脂质性肺炎（ExLP）和内源性脂质性肺炎（EnLP）。外源性脂质性肺炎由吸入吸脂物质（动物脂肪、植物油或矿物油）引起，在成人病例中，这些物质大多是用于治疗便秘或鼻咽炎的药物。这些患者大多表现出轻微的临床症状和慢性疾病状态。有报道称脂质性肺炎可通过使用皮质类固醇、免疫球蛋白和全肺灌洗成功治疗。我们报告一例以高热和急性疾病状态为特征的外源性脂质性肺炎病例。一名77岁患有高血压和糖尿病的女性因“不完全性肠梗阻”接受了石蜡油治疗，随后发生误吸意外，因为她有进食时咳嗽的病史，随后出现持续高热和白细胞（WBC）升高。胸部CT显示进行性磨玻璃样混浊，并伴有实变融合，她的痰液病原学检查为阴性，广谱抗生素治疗无效。该患者接受了纤维支气管镜检查及支气管肺泡灌洗（BAL）。支气管肺泡灌洗液（BALF）无色透明，未呈乳状外观。BALF的细胞总数为2.0×10⁶个/mL，其中巨噬细胞占7.2%，中性粒细胞占92.8%。BALF的细菌、真菌和分枝杆菌病原体培养均为阴性。BALF细胞学检查发现有空泡的充满脂质的巨噬细胞（油红O染色）。这些发现揭示为外源性脂质性肺炎。有报道称脂质性肺炎可通过使用皮质类固醇、免疫球蛋白和全肺灌洗成功治疗。因此该患者接受了甲泼尼龙120mg/d治疗3天，80mg/d治疗6天，同时给予免疫球蛋白静脉输注，但患者每日最高体温在38至39度之间波动。然后，在入院28天后进行了全肺灌洗。不幸的是，手术过程中因气管插管问题发生了急性肺水肿，6天后，患者最终死亡。外源性脂质性肺炎的临床表现差异很大，从无症状到危及生命的症状都有，以发热低热为主要表现，但高热也可能是显著表现。
