D103-07 Exogenous Lipoid Pneumonia Managed With Whole Lung Lavage
Abstract
Exogenous lipoid pneumonia (ELP) is a rare interstitial lung disease resulting from aspiration or inhalation of lipid-containing substances such as mineral oils or petroleum-based products. Diagnosis is challenging, often mimicking infectious or inflammatory lung disease, and requires histopathologic confirmation of lipid-laden macrophages. Management involves discontinuation of exposure, corticosteroid therapy, and in severe cases whole-lung lavage (WLL) to remove accumulated lipid material. This case highlights diagnostic complexity and multidisciplinary management of ELP with organizing pneumonia.
A 47-year-old man with chronic sinusitis on dupilumab, prior smoking (2002-2018), and vaping (2018-2024) presented with 18 months of progressive dyspnea, with his modified Medical Research Council dyspnea scale ranging from grade 2-3, and a productive cough. Pulmonary function testing showed restriction with FVC 2.41 L (43% predicted), FEV1 1.77 L (40%), and FEV1/FVC 0.80. Chest CT demonstrated diffuse centrilobular nodules, bronchial wall thickening, and ground-glass opacities. Bronchoscopy grew Haemophilus influenzae with minimal improvement after antibiotics. Persistent symptoms prompted surgical lung biopsy which revealed exogenous lipoid pneumonia with organizing pneumonia and bronchitis. Prednisone and trimethoprim-sulfamethoxazole prophylaxis provided limited improvement in clinical symptoms. He was referred to our institution for a second opinion. Extensive history…
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