An unusual case of recurrent chest infections

Abstract

This case presentation relates to a 53 year old male, cachectic in appearance, who presented with progressively worsening dyspnoea, cough, intermittent haemoptysis and a history of nasal dryness ongoing over five months. The patient had received multiple courses of oral antibiotics for suspected community acquired pneumonia with no significant improvement. He was referred to our Respiratory Department for further evaluation of his symptoms. His HRCT showed right middle lobe consolidation with central cavitations. Furthermore, the transbronchial biopsy had been performed and the cytological examination revealed lipid laden macrophage with interstitial inflammatory changes. With return to the patient over the counter drug history, he described the frequent use of petroleum jelly to alleviate the symptoms of nasal dryness. This is the first report case of exogenous lipoid pneumonia presented with haemoptysis and cavitations in the HRCT.

Fig. 1

Right middle consolidation with central clearance suggesting possible cavity.

Fig. 2

Medium power cytological examination showed lipid macrophages (the red arrow) and interstitial inflammatory changes within the lung parenchyma. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 3

High power cytological examination showed lipid macrophages within the lung interstitial tissue (the red arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 4

CT Thorax demonstrated improvement in the right middle lobe consolidation three months after stopping the petroleum jelly.