Not your typical pneumonia: a case of exogenous lipoid pneumonia

Abstract

The constellation of chronic cough, dyspnea, and hemoptysis can include a broad range of differential diagnoses. Although uncommon, exogenous lipoid pneumonia (ELP) should be considered when patients present with this symptom complex. We report a case of a 72-year-old female who presented with hemoptysis, cough, and dyspnea. The admission computed tomography scan of the chest revealed progressive interstitial infiltrates. Bronchoscopy revealed diffuse erythema without bleeding. Culture and cytology of lavage fluid were negative. Open-lung biopsy revealed numerous lipid-laden macrophages and multinucleated foreign-body giant cells. On further questioning, the patient admitted to the daily use of mineral oil for constipation. The diagnosis of ELP was made. The literature review revealed that many cases typically present with chronic cough with or without dyspnea. Our case illustrates an unusual presenting symptom of hemoptysis and the need to identify patients who can be at risk of developing this rare condition.

Figure 1

Admission chest x-ray demonstrating interstitial infiltrates

Figure 2

Chest CT scan showing interstitial infiltrates in a cobblestoning pattern

Figure 3

Hematoxylin and eosin stained slides with both low power (×10) and high power (×40) microscopic view of alveolar and interstitial spaces with lipid-laden macrophages (indicated by arrows)