Lipoid pneumonia in a gas station attendant

Abstract

The exogenous lipoid pneumonia, uncommon in adults, is the result of the inhalation and/or aspiration of lipid material into the tracheobronchial tree. This is often confused with bacterial pneumonia and pulmonary tuberculosis due to a nonspecific clinical and radiologic picture. It presents acutely or chronically and may result in pulmonary fibrosis. We describe here a case of lipoid pneumonia in a gas station attendant who siphoned gasoline to fill motorcycles; he was hospitalized due to presenting with a respiratory infection that was hard to resolve. The patient underwent bronchoscopy with bronchoalveolar lavage, which, on cytochemical (oil red O) evaluation, was slightly positive for lipid material in the foamy cytoplasm of alveolar macrophages. Due to his occupational history and radiographic abnormalities suggestive of lipoid pneumonia, a lung biopsy was performed to confirm the diagnosis. The patient was serially treated with segmental lung lavage and showed clinical, functional, and radiological improvement.

Figure 1

Patient siphoning excess gasoline in filling vehicles due to wrong information provided by the clients.

Figure 2

(a) PA chest radiograph: consolidations at lung bases. (b) Chest HRCT: nonhomogeneous consolidations, ground-glass opacities, areas of fibrosis with parenchymal beams, and bronchiectasis traction. (c) Segmental pulmonary lavage fluid: cloudy with halo of fatty supernatant. (d) Bronchoalveolar lavage fluid: presence of macrophages with foamy cytoplasm showing positive oil red O staining. (e) Histopathologic section of lung (oil red O, 400x) showing orange-colored lipid contents “lipid laden macrophages.”