Exogenous Lipoid Pneumonia: An Unexpected Complication of Substance Abuse

Michael N. Gurell; R. Matthew Kottmann; Haodong Xu; Patricia J. Sime

doi:10.7326/0003-4819-149-5-200809020-00027

Letters |2 September 2008

Exogenous Lipoid Pneumonia: An Unexpected Complication of Substance Abuse

Michael N. Gurell, MD; R. Matthew Kottmann, MD; Haodong Xu, MD; Patricia J. Sime, MD

Article, Author, and Disclosure Information

Background: Exogenous lipoid pneumonia is an uncommon cause of pulmonary infiltrates resulting from aspiration or inhalation of fat-like material. It is often unrecognized because its symptoms and radiographic appearances are nonspecific and mimic many pulmonary diseases. Generally, affected patients use oil-based laxatives and have risk factors for aspiration. It is not classically considered a consequence of substance abuse.

Objective: To describe a patient with exogenous lipoid pneumonia caused by inhalation of crack cocaine mixed with petroleum jelly.

Case Report: A 42-year-old black man was evaluated for a 6-month history of progressively worsening dyspnea on exertion. He denied associated symptoms, including cough, wheezing, or fever. His medical history included paranoid schizophrenia, and he smoked crack cocaine and tobacco. He lived in a boarding house, had previous exposure to asbestos, and had a remote history of incarceration. His medications included fluticasone, ipratropium, and albuterol inhalers; haloperidol; quetiapine; trihexyphenidyl; and occasional celecoxib. On examination, his blood pressure and heart rate were normal. His oxygen saturation was 93% on room air, which decreased to 88% after 1 minute of ambulation. Fine inspiratory crackles were heard in both lung bases. Pulmonary function tests showed a combined restrictive and obstructive ventilatory defect with a severe reduction in diffusion capacity (27% predicted). Chest radiography showed extensive, diffuse fine reticular infiltrates (Figure 1). Complete blood count, chemistries, and coagulation studies were all normal. Purified protein derivative and HIV test results were negative.

FULL TEXT

PDF

Not Available

2008 American College of Physicians

Letters |2 September 2008

Exogenous Lipoid Pneumonia: An Unexpected Complication of Substance Abuse

Content

Information For

Services

Awards and Cover

Other Resources

Follow Annals On

Letters |2 September 2008

Exogenous Lipoid Pneumonia: An Unexpected Complication of Substance Abuse

Content

Information For

Services

Awards and Cover

Other Resources

Follow Annals On

You need a subscription to this content to use this feature.