Letter to the Editor
Fire Eater's Pneumonia: The Role of Computed Tomography
Neumonía del tragafuegos: el papel de la tomografía computarizada
Edson Marchiori
, Arthur Soares-Souza, Gláucia Zanetti
Corresponding author
Departamento de Radiología, Federal University of Rio de Janeiro, Río de Janeiro, Brazil
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(B) Follow-up computed tomography with the lung window setting demonstrated reabsorption of the mass, with residual scarring. (C) Alveolar macrophages recovered by bronchoalveolar lavage. The cytoplasm is full of large rounded vacuoles that displace nuclei to the periphery.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the recent letter to the editor from Lizarzábal Suárez et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> describing the case of a 19-year-old man who aspirated liquid paraffin during a fire-eating act. The patient developed lipoid pneumonia, and chest computed tomography showed three cavitary lesions in the pulmonary parenchyma.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We would like to highlight the findings from a similar case recently encountered. A 26-year-old man was admitted with dyspnea, cough, fever (39<span class="elsevierStyleHsp" style=""></span>°C), and chest pain. Two days before admission, he had accidentally aspirated liquid paraffin during a fire-eating act. Blood count revealed elevated white blood cells, with a leftward shift. Other laboratory data were unremarkable. Computed tomography demonstrated a heterogeneous mass in the right lower lobe, adjacent to the pleural surface (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Bronchoscopy revealed inflamed, hyperemic bronchial mucosa without purulence or evidence of necrosis. Bronchoalveolar lavage fluid showed numerous lipid-laden macrophages (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). The patient was treated with systemic steroids and antibiotics. Computed tomography performed 2 weeks after admission showed remarkable improvement, with reabsorption of the mass, leaving residual scarring (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Fire eater's pneumonia (FEP) is caused by the accidental acute aspiration of hydrocarbon products during a fire-blowing act.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–4</span></a> The performer blows a mouthful of liquid hydrocarbon against a burning stick, thereby creating an aerosol that ignites around the stick.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> If aspirated, these hydrocarbons can diffuse rapidly throughout the bronchial tree, inducing bronchial edema, tissue damage, and surfactant destruction. As a consequence, the compounds provoke macrophage activation and cause a local inflammatory reaction.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The diagnosis of FEP is reached by carefully evaluating the patient's anamnesis and clinical characteristics. Symptoms at presentation include cough, dyspnea, fever, and chest pain after hydrocarbon aspiration.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a> The diagnosis can also be confirmed by the presence of lipid-laden macrophages in bronchoalveolar lavage fluid in the context of recent exposure to volatile hydrocarbons.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,4</span></a> Tomographic findings in patients with FEP include unilateral or bilateral lung consolidation, with or without low attenuation caused by lipid density or necrosis,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> well-defined nodules, pneumatoceles (well-defined cavitary nodules), pleural effusion, and spontaneous pneumothorax.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The lesions commonly involve both lower lobes.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">FEP is a pseudo-infectious lung disease characterized by the intense release of inflammatory cytokines. The use of steroids is controversial, but this treatment may improve the outcome in severely affected patients. Prophylactic antibiotics seem to be of benefit, as fever and an elevated leukocyte count can occur and may indicate associated bacterial pneumonia.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,4</span></a> Most patients with FEP experience complete recovery within weeks. However, complications such as pulmonary abscess, effusion, bronchopleural fistula formation, and bacterial superinfection may develop.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> In conclusion, FEP should be included in the differential diagnosis of pneumonias. Clinical diagnosis is based on recent exposure to volatile hydrocarbons, as symptoms and imaging findings are nonspecific.</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: Marchiori E, Soares-Souza A, Zanetti G. Neumonía del tragafuegos: el papel de la tomografía computarizada. Arch Bronconeumol. 2016;52:282–283.</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" => 986 "Ancho" => 1399 "Tamanyo" => 264900 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Computed tomography with the mediastinal window setting shows a mass in the right lower lobe, adjacent to the pleural surface. (B) Follow-up computed tomography with the lung window setting demonstrated reabsorption of the mass, with residual scarring. (C) Alveolar macrophages recovered by bronchoalveolar lavage. The cytoplasm is full of large rounded vacuoles that displace nuclei to the periphery.</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" => "Lipoid pneumonia due to accidental aspiration of paraffin in a “fire-eater”" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.C. Lizarzábal Suárez" 1 => "E. Núñez Savall" 2 => "F. 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Pérez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiographics.20.3.g00ma01673" "Revista" => array:6 [ "tituloSerie" => "Radiographics" "fecha" => "2000" "volumen" => "20" "paginaInicial" => "673" "paginaFinal" => "685" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10835120" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005200000005/v1_201604270052/S1579212915003316/v1_201604270052/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000005/v1_201604270052/S1579212915003316/v1_201604270052/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915003316?idApp=UINPBA00003Z" ]
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| 2019 August | 27 | 16 | 43 |
| 2019 July | 35 | 19 | 54 |
| 2019 June | 28 | 7 | 35 |
| 2019 May | 36 | 26 | 62 |
| 2019 April | 60 | 30 | 90 |
| 2019 March | 41 | 21 | 62 |
| 2019 February | 35 | 19 | 54 |
| 2019 January | 24 | 12 | 36 |
| 2018 December | 32 | 19 | 51 |
| 2018 November | 69 | 13 | 82 |
| 2018 October | 87 | 28 | 115 |
| 2018 September | 18 | 10 | 28 |
| 2018 May | 9 | 1 | 10 |
| 2018 April | 37 | 5 | 42 |
| 2018 March | 45 | 1 | 46 |
| 2018 February | 51 | 6 | 57 |
| 2018 January | 124 | 3 | 127 |
| 2017 December | 32 | 10 | 42 |
| 2017 November | 20 | 7 | 27 |
| 2017 October | 19 | 11 | 30 |
| 2017 September | 17 | 3 | 20 |
| 2017 August | 24 | 10 | 34 |
| 2017 July | 16 | 4 | 20 |
| 2017 June | 28 | 14 | 42 |
| 2017 May | 25 | 6 | 31 |
| 2017 April | 17 | 5 | 22 |
| 2017 March | 11 | 4 | 15 |
| 2017 February | 25 | 3 | 28 |
| 2017 January | 10 | 3 | 13 |
| 2016 December | 31 | 11 | 42 |
| 2016 November | 34 | 17 | 51 |
| 2016 October | 30 | 26 | 56 |
| 2016 September | 34 | 4 | 38 |
| 2016 August | 37 | 3 | 40 |
Show all
