Letter to the Editor
Lipoid Pneumonia due to Accidental Aspiration of Paraffin in a “Fire-Eater”
Neumonía lipoidea por aspiración accidental de parafina en un «comedor de fuego»
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(Top left) hematoxylin–eosin (HE) with monoclonal antibody CD163, 400×. (Below) hematoxylin–eosin (HE) with para-aminosalicylic acid (PAS), 400×.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Exogenous lipoid pneumonia is a rare entity. It was first characterized in 1925, when Laughlen published a case of lipoid pneumonia caused by a nasopharyngeal injection of oil.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> As this phenomenon is rare, we would like to report a new case of lipoid pneumonia, presenting in this case in a “fire-eater” who accidently inhaled paraffin during a circus act performed in the street.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 19-year-old man, presented with dry cough, dyspnea, general malaise, and right rib pain after an episode of choking on paraffin during a fire-eating act. He smoked 2 cigarettes/day (accumulated smoking history of 3 pack-years) and worked as an amateur circus street performer. Physical examination revealed temperature 38.5<span class="elsevierStyleHsp" style=""></span>°C, and disperse wheezing on exhalation on auscultation. Clinical laboratory test results included 27<span class="elsevierStyleHsp" style=""></span>100 leukocytes/μl (91% neutrophils) and CRP 298<span class="elsevierStyleHsp" style=""></span>mg/l. Chest X-ray showed bilateral alveolar infiltrates and computed tomography (CT) revealed 3 cavities, the largest being 35<span class="elsevierStyleHsp" style=""></span>mm in diameter, in the middle lobe, and 1 in the left lower lobe, with partial fluid occupation and remains of low-density material (−3 to −50<span class="elsevierStyleHsp" style=""></span>HU) of lipid origin. Fiberoptic bronchoscopy was normal, and bronchoalveolar lavage fluid revealed 59% neutrophils, 17% lymphocytes, and 24% histiocytes; cultures for bacteria, mycoses and mycobacteria were negative. Sputum cytology showed numerous macrophages with clear, foamy cytoplasm, consistent with aspiration of foreign matter (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Antibiotic treatment was started (amoxicillin-clavulanate acid for 2 weeks) and corticosteroids (methylprednisolone 60<span class="elsevierStyleHsp" style=""></span>mg/day/i.v. for 1 week, followed by prednisone, tapered over a 10-day period). The patient showed clinical and radiological improvement. In the follow-up in the outpatient clinic, he was asymptomatic and chest X-ray and lung function tests were normal (FVC 4370<span class="elsevierStyleHsp" style=""></span>ml, 84% predicted; FEV<span class="elsevierStyleInf">1</span> 4100<span class="elsevierStyleHsp" style=""></span>ml, 93%; FEV<span class="elsevierStyleInf">1</span>%/FVC 94; DLCOsb 82%; DLCO/VA 100%).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Our patient presented with an acute form of lipoid pneumonia. This is of interest due to the unusual nature of its origin: accidental aspiration of paraffin in a street performer during a circus act in the street. Clinical presentation, unlike chronic forms, develops with sudden onset of dyspnea, fever, coughing fits, chest pressure, and, in some cases, hemoptysis. To our knowledge, the first case of lipoid pneumonia in a fire eater dates from 1984<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> and some isolated cases have been reported since then.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Areas of homogeneous condensation with a diffuse or localized air bronchogram can been seen on chest X-ray. The extension of parenchymal damage can be documented with CT, and in our case, cavities occupied with low density material, consistent with lipid origin,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> were seen with this technique. These cavities were pneumatoceles, which can take more than 2 months to resolve.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The diagnosis is based on a finding of macrophages containing lipid vacuoles, as observed in the sputum samples of our patient.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, this was a case of lipoid pneumonia due to aspiration of paraffin in an amateur fire-eater. It is a very rare disease, but incidence rates may rise in the near future.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lizarzábal Suárez PC, Núñez Savall E, Carrión Valero F. Neumonía lipoidea por aspiración accidental de parafina en un «comedor de fuego». Arch Bronconeumol. 2015;51:530–531.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1159 "Ancho" => 1300 "Tamanyo" => 371951 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(Top right) hematoxylin–eosin (HE), 400×. (Top left) hematoxylin–eosin (HE) with monoclonal antibody CD163, 400×. (Below) hematoxylin–eosin (HE) with para-aminosalicylic acid (PAS), 400×.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pneumonia following nasopharyngeal injections of oil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G.F. 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Erasmus" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Roentgenol" "fecha" => "2010" "volumen" => "194" "paginaInicial" => "103" "paginaFinal" => "109" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fire eater's pneumonia: radiographic CT findings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Franquet" 1 => "D. Gómez Santos" 2 => "A. Giménez" 3 => "S. Torrubia" 4 => "J.M. 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Lode" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2003" "volumen" => "124" "paginaInicial" => "398" "paginaFinal" => "400" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12853552" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000010/v1_201509302252/S1579212915002785/v1_201509302252/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000010/v1_201509302252/S1579212915002785/v1_201509302252/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915002785?idApp=UINPBA00003Z" ]
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| 2021 May | 36 | 26 | 62 |
| 2021 April | 79 | 69 | 148 |
| 2021 March | 53 | 38 | 91 |
| 2021 February | 33 | 22 | 55 |
| 2021 January | 22 | 24 | 46 |
| 2020 December | 27 | 19 | 46 |
| 2020 November | 25 | 14 | 39 |
| 2020 October | 30 | 17 | 47 |
| 2020 September | 25 | 10 | 35 |
| 2020 August | 26 | 15 | 41 |
| 2020 July | 26 | 26 | 52 |
| 2020 June | 28 | 8 | 36 |
| 2020 May | 35 | 14 | 49 |
| 2020 April | 37 | 17 | 54 |
| 2020 March | 38 | 9 | 47 |
| 2020 February | 32 | 23 | 55 |
| 2020 January | 42 | 12 | 54 |
| 2019 December | 45 | 26 | 71 |
| 2019 November | 43 | 26 | 69 |
| 2019 October | 39 | 14 | 53 |
| 2019 September | 45 | 31 | 76 |
| 2019 August | 111 | 13 | 124 |
| 2019 July | 38 | 13 | 51 |
| 2019 June | 18 | 14 | 32 |
| 2019 May | 47 | 18 | 65 |
| 2019 April | 62 | 39 | 101 |
| 2019 March | 35 | 22 | 57 |
| 2019 February | 32 | 24 | 56 |
| 2019 January | 34 | 22 | 56 |
| 2018 December | 38 | 14 | 52 |
| 2018 November | 61 | 14 | 75 |
| 2018 October | 79 | 33 | 112 |
| 2018 September | 32 | 17 | 49 |
| 2018 May | 15 | 2 | 17 |
| 2018 April | 34 | 6 | 40 |
| 2018 March | 28 | 6 | 34 |
| 2018 February | 38 | 9 | 47 |
| 2018 January | 128 | 4 | 132 |
| 2017 December | 149 | 4 | 153 |
| 2017 November | 36 | 6 | 42 |
| 2017 October | 17 | 3 | 20 |
| 2017 September | 14 | 6 | 20 |
| 2017 August | 20 | 11 | 31 |
| 2017 July | 14 | 7 | 21 |
| 2017 June | 40 | 17 | 57 |
| 2017 May | 30 | 11 | 41 |
| 2017 April | 37 | 7 | 44 |
| 2017 March | 16 | 10 | 26 |
| 2017 February | 10 | 4 | 14 |
| 2017 January | 13 | 5 | 18 |
| 2016 December | 22 | 7 | 29 |
| 2016 November | 32 | 10 | 42 |
| 2016 October | 41 | 9 | 50 |
| 2016 September | 34 | 22 | 56 |
| 2016 August | 38 | 11 | 49 |
| 2016 July | 48 | 19 | 67 |
| 2016 May | 0 | 9 | 9 |
| 2016 April | 0 | 1 | 1 |
| 2016 March | 3 | 0 | 3 |
| 2016 February | 1 | 1 | 2 |
| 2016 January | 0 | 10 | 10 |
| 2015 October | 1 | 1 | 2 |
Show all
