open access

Vol 81, No 5 (2013)
CASE REPORTS
Submitted: 2013-08-22
Accepted: 2013-08-22
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Lipoid pneumonia — a case of refractory pneumonia in a child treated with ketogenic diet

Piotr Buda, Anna Wieteska-Klimczak, Anna Własienko, Agnieszka Mazur, Jerzy Ziołkowski, Joanna Jaworska, Andrzej Kościesza, Dorota Dunin-Wąsowicz, Janusz Książyk
Pneumonol Alergol Pol 2013;81(5):448-452.

open access

Vol 81, No 5 (2013)
CASE REPORTS
Submitted: 2013-08-22
Accepted: 2013-08-22

Abstract

Lipoid pneumonia (LP) is a chronic inflammation of the lung parenchyma with interstitial involvement due to the accumulation of endogenous or exogenous lipids. Exogenous LP (ELP) is associated with the aspiration or inhalation of oil present in food, oil-based medications or radiographic contrast media. The clinical manifestations of LP range from asymptomatic cases to severe pulmonary involvement, with respiratory failure and death, according to the quantity and duration of the aspiration. The diagnosis of exogenous lipoid pneumonia is based on a history of exposure to oil and the presence of lipid-laden macrophages on sputum or bronchoalveolar lavage (BAL) analysis. High-resolution computed tomography (HRCT) is the imaging technique of choice for evaluation of patients with suspected LP. The best therapeutic strategy is to remove the oil as early as possible through bronchoscopy with multiple BALs and interruption in the use of mineral oil. Steroid therapy remains controversial, and should be reserved for severe cases. We describe a case of LP due to oil aspiration in 3-year-old girl with intractable epilepsy on ketogenic diet. Diagnostic problems were due to non-specific symptoms that were mimicing serious infectious pneumonia. A high index of suspicion and precise medical history is required in cases of refractory pneumonia and fever unresponsive to conventional therapy. Gastroesophageal reflux and a risk of aspiration may be regarded as relative contraindications to the ketogenic diet. Conservative treatment, based on the use of oral steroids, proved to be an efficient therapeutic approach in this case.

Abstract

Lipoid pneumonia (LP) is a chronic inflammation of the lung parenchyma with interstitial involvement due to the accumulation of endogenous or exogenous lipids. Exogenous LP (ELP) is associated with the aspiration or inhalation of oil present in food, oil-based medications or radiographic contrast media. The clinical manifestations of LP range from asymptomatic cases to severe pulmonary involvement, with respiratory failure and death, according to the quantity and duration of the aspiration. The diagnosis of exogenous lipoid pneumonia is based on a history of exposure to oil and the presence of lipid-laden macrophages on sputum or bronchoalveolar lavage (BAL) analysis. High-resolution computed tomography (HRCT) is the imaging technique of choice for evaluation of patients with suspected LP. The best therapeutic strategy is to remove the oil as early as possible through bronchoscopy with multiple BALs and interruption in the use of mineral oil. Steroid therapy remains controversial, and should be reserved for severe cases. We describe a case of LP due to oil aspiration in 3-year-old girl with intractable epilepsy on ketogenic diet. Diagnostic problems were due to non-specific symptoms that were mimicing serious infectious pneumonia. A high index of suspicion and precise medical history is required in cases of refractory pneumonia and fever unresponsive to conventional therapy. Gastroesophageal reflux and a risk of aspiration may be regarded as relative contraindications to the ketogenic diet. Conservative treatment, based on the use of oral steroids, proved to be an efficient therapeutic approach in this case.

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Keywords

lipoid pneumonia, refractory pneumonia, ketogenic diet, aspiration, epilepsy

About this article
Title

Lipoid pneumonia — a case of refractory pneumonia in a child treated with ketogenic diet

Journal

Advances in Respiratory Medicine

Issue

Vol 81, No 5 (2013)

Pages

448-452

Bibliographic record

Pneumonol Alergol Pol 2013;81(5):448-452.

Keywords

lipoid pneumonia
refractory pneumonia
ketogenic diet
aspiration
epilepsy

Authors

Piotr Buda
Anna Wieteska-Klimczak
Anna Własienko
Agnieszka Mazur
Jerzy Ziołkowski
Joanna Jaworska
Andrzej Kościesza
Dorota Dunin-Wąsowicz
Janusz Książyk

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