Symptoms
Lipid pneumonia manifests as nonspecific symptoms such as chronic cough, sputum, hemoptysis, respiratory distress (dyspnea), fever (intermittent), chest pain, and weight loss due to increased work of breathing in hypoxia. Possible complications include superinfections. The disease was first described by G.F. Laughlen in 1925. He published two cases caused by ingestion of kerosene and two cases caused by use of nasal drops containing mineral oil.
Causes
Lipid pneumonia is caused by aspiration or inhalation of fatty or mineral oils, which are deposited in the lung cavity and initiate inflammatory reactions. Histologically, alveolar and interstitial lipid-laden macrophages with numerous vesicles are detectable. Radiographs show diffuse patches on the lungs. Fibrosis (connective tissue proliferation) and limitation of respiratory function develop as the disease progresses. The most commonly described trigger is the mineral oil kerosene, a mixture of liquid saturated hydrocarbons derived from petroleum, which is taken to treat chronic constipation or used as a nasal oil (see also under kerosene as a laxative). Kerosene also passes well into the lungs because it inhibits mucociliary transport and does not trigger the cough reflex. Vaseline, as well as vegetable and animal oils and fats, can also cause lipid pneumonia. These substances are found, for example, in nasal oils, nasal ointments, lip balms, and laxatives. The underlying condition is usually a chronic disease that is treated with the corresponding drugs over a long period of time, for example, congestion, inflammation of the nasal mucosa or a dry nose. Use before bedtime, gastroesophageal reflux and mental illness can promote its development. Young children, the chronically ill, bedridden individuals, and people with swallowing difficulties are also among the risk groups for lipid aspiration. Furthermore, exposure to such substances is possible in industrial settings.
Diagnosis
Diagnosis is complicated by the fact that the disease is rare and clinical symptoms are nonspecific. It is made on the basis of history, lung biopsy, imaging, and pulmonary function tests, among other tests. Differential diagnoses include endogenous lipid pneumonia, which is caused by endogenous lipids, and numerous other lung diseases.
Prevention
Trigger medications should be used sparingly or not at all. Appropriate products can be well replaced by other means. For example, aqueous-based nasal products are used almost exclusively today. Numerous better tolerated laxatives are commercially available.
Treatment
Measures for treatment have not been well studied. Triggering medications should be discontinued as soon as possible, and underlying conditions such as gastroesophageal reflux should be treated. A washout of the lungs should partially remove the foreign bodies. In some cases, oral glucocorticoids have been used, and in cases of severe respiratory restriction, Sauserstoff has been used.
Situation in many countries
Nasal oils based on mineral oils or fatty oils are very rarely used today, partly because many preparations are no longer commercially available. Kerosene is still present in some laxatives. It is difficult to estimate how great the danger is with emulsified kerosene. Greasy nasal ointments and lip balms should also not be used excessively – corresponding cases are documented in the literature. Pure kerosene should not be sold as a laxative in pharmacies or drugstores. The production of paraffin-based nasal oils should also be avoided.
