Nasal application of petrolatum ointment - A silent cause of exogenous lipoid pneumonia: Successfully treated with prednisolone

Abstract

We report a case of exogenous lipoid pneumonia from chronic, extranasal use of petrolatum ointment (Vicks VapoRub in this case) for nasal decongestion in a young woman, presenting with cough, dyspnea and fever. Exogenous Lipoid pneumonia is a rare condition, underdiagnosed and is more prevalent in adults. Usually asymptomatic and diagnosed while evaluating predisposed patients who become clinically unstable or an abnormal lung shadow or during evaluation of rhinobronchial allergy. It is rarely reported from chronic use of petrolatum ointment extranasally and was diagnosed by transbronchial biopsy in the present case. She was found, retrospectively, to have been using petrolatum ointment, as an extranasal application since more than a year at bedtime. She didn't give history of using any other oil-based nasal topical vasoconstrictor preparations for sinusitis. Our patient was managed with discontinuation of further use of the petrolatum ointment and treatment with prednisolone apart from her regular treatment for chronic rhinobronchial allergy. Patient is stable without any further radiological deterioration during follow-up of one year.

Keywords: Exogenous lipoid pneumonia; Petrolatum ointment; Prednisolone; Transbronchial lung biopsy; Treatment.

Fig. 1

Axial HRCT section at the level of the lower chest reveals multiple tiny centrilobular nodules in the posterior basal segment of the left lower lobe and few nodules in the left lingula, right middle lobe and lateral basal segment of the right lower lobe.

Fig. 2

Sagittal HRCT section of the left lung reveals foci of ground glass haziness and tiny nodules in the lower lobe and inferior lingula.

Fig. 3

H&E section (200×) showing lung tissue composed of alveolar spaces with flattened lining, a few spaces show desquamation of the lining epithelium. Alveolar spaces are filled with macrophages with vacuoles of varying sizes.

Fig. 4

HRCT section at the level of the lower lobes reveals mild cylindrical bronchiectasis in the left lower lobe, faint tiny centrilobular nodules in the left lower lobe, right lower lobe and fibrotic lesions in the left lingula.