The man with a high fever of 40 degrees into the ICU was the scourge of "paraffin oil"

Mr. Hu, 64, still had high fever after being hospitalized in the local hospital due to repeated fever, cough and sputum production, and finally transferred to ricu of the Respiratory and Critical Care Medicine Department of the Second People's Hospital of Hunan Province (Hunan Provincial Brain Hospital), and was diagnosed with "lipid-like pneumonia", and the "culprit" behind it was "paraffin oil". After active treatment, the patient has now turned the crisis into safety and has been smoothly transferred to the general ward for continued treatment.

The treatment of pneumonia is not effective, and the expert team has identified the culprit

Mr. Hu suffered from hypertension and cerebral infarction for more than 10 years, more than 10 days ago due to cough and sputum and fever after a cold, hospitalized in the local hospital for 29 days, repeated fever, body temperature up to 42 degrees Celsius, review lung lesions compared with the previous obvious progress, family rushed to transfer him to the Second People's Hospital of Hunan Province for treatment.

Due to the critical condition, the patient was admitted to the Respiratory and Critical Care Medicine Department RICU, Chief Physician Zeng Xiangbo and his team organized expert consultation after receiving the consultation, that Mr. Hu's condition can not be explained by conventional bacterial pneumonia, double multiple inflammatory changes, many of which vary in size and very low density shadow close to fat density, suspected that oil inhalation pneumonia may be possible, immediately for the patient to perform electronic fiber bronchoscopy + alveolar lavage + lung biopsy, microscopic visible bilateral main bronchi has a large number of viscous secretions, the pipeline has blockage phenomenon, The swelling of the bronchial mucosa is obvious, the alveolar lavage fluid is cloudy and green, and the lavage fluid and lung biopsy are left for microbiology and pathology, and the results are returned: a small amount of lipid droplet-like transparent vacuoles. Culture of no pathogenic microorganisms.

Based on this result, the medical history was continued to be followed, and it was found that the patient had used liquid paraffin nasal feeding to induce diarrhea due to constipation during his hospitalization in the local hospital, and had vomiting, suspicious cough and aspiration. Combined with the medical history, imaging data, and pathological results of alveolar lavage fluid, the final diagnosis is definitive: lipid-like pneumonia.

What is lipid-like pneumonia?

Chief physician Zeng Xiangbo introduced that lipid-like pneumonia was first proposed by Laughlen in 1925, because its clinical manifestations are similar to a variety of lung diseases, and it is easy to delay diagnosis. Lipid-like pneumonia is divided into exogenous and endogenous, of which exogenous is more common. Exogenous lipoid pneumonia is a rare chronic idiopathic lung disease caused by inhalation or accidental inhalation of various lipids into the lungs. After these lipids enter the trachea and bronchi, they inhibit the ciliary motor system of the bronchial wall, make the cilia lose their ability to move, damage the pseudolayer ciliated columnar epithelium, enter the alveolar cavity and are engulfed by macrophages, because they cannot be dissolved, promote local inflammatory responses, and form granulomas and fibrosis.

Zeng Xiangbo introduced that gastroesophageal reflux and cough aspiration are the main reasons for exogenous lipid substances (such as mineral oil, vegetable oil, liquid paraffin wax, etc.) into the respiratory tract. Patients are bedridden at an advanced age, prone to constipation, and often use liquid paraffin oil as a laxative in the clinic, and are prone to accidental inhalation into the lungs during coughing or reflux. Common situations include occupational contact such as paint, decoration, etc.; in the iatrogenic environment, such as the commonly used method of administration of nasal drops, oral administration, etc. can also be caused.

The clinical manifestations and signs of exogenous lipid pneumonia lack specificity and vary in severity, common symptoms are cough, sputum production, fever, and uncommon symptoms include hemoptysis, chest pain, chest tightness, and pleural effusion, and in severe cases, dyspnea and chest pain may occur. At the same time, imaging also lacks specificity and is easy to misdiagnose. The key point of diagnosis is to carefully ask for a history. In addition, if the following pathological features are present, the bronchoalveolar lavage fluid can be seen with lipid-engulfing macrophages and alveolar macrophage histopathology showing lipid-engulfing macrophages and foamy macrophages in the alveolar cavity and interstitium.

Zeng Xiangbo said that in terms of treatment, there is no particularly effective means at present, so prevention is the key. Lipid exposure should be discontinued after diagnosis; whole lung/local lobe lavage has been reported in infant and young children; systemic glucocorticoid therapy may be given in acutely ill patients with acute and heavy lipid inhalation; and surgical resection may be considered for local lesions. As long as early detection, early diagnosis, and aggressive treatment, the prognosis is generally good.

Correspondent Gong Lijuan Xiaoxiang Morning News reporter Xia Sheng