Delayed pulmonary abscess following hydrocarbon aspiration in a fire breather: a case report

Introduction Reports of hydrocarbon aspiration pneumonitis are infrequent. In addition, delayed complications are uncommon but recognised in the literature.Case A 25-year-old male fire breather accidentally aspirated unlit naphtha hydrocarbon fuel during a performance. He developed cough, dyspnoea, chest pain, epigastric pain, vomiting, and diarrhoea, and was diagnosed with aspiration pneumonitis and mild oesophageal injury. Treatment with intravenous antibiotics and steroids led to clinical improvement and discharge within 1 week. Eighteen days after the initial exposure, he re-presented to the hospital with haemoptysis, fever, dyspnoea, and worsening chest pain. Computed tomography demonstrated pulmonary abscesses with necrotising features. He was re-commenced on intravenous antibiotics and had significant analgesic requirements. Percutaneous drainage was considered but ultimately not required. He achieved full clinical recovery following a prolonged course of antibiotic therapy.Discussion This case highlights how delayed biphasic deterioration may occur despite apparent early recovery after hydrocarbon aspiration and suggests non-invasive management may be feasible in selected, closely monitored patients with an improving clinical trajectory.