C59-08 Not So Fabulous - A Case of Acute Chemical Pneumonitis After Household Cleaner Use

Abstract Background Acute chemical pneumonitis is an inflammatory lung injury resulting from inhalation of toxic substances such as fumes or aerosols. Although typically linked to occupational exposure, household cleaning agents are increasingly implicated, particularly in enclosed or poorly ventilated settings. According to the American Association of Poison Control Centers, more than 80,000 annual exposures involve household cleaners, with nearly 10% due to inhalation injury. Case Presentation A 68-year-old male with end-stage renal disease, hypertension, and type 2 diabetes presented with altered mental status and was admitted for acute metabolic encephalopathy. On hospital day 2, he developed hypoxemia and bilateral infiltrates on chest X-ray initially attributed to fluid overload. Despite ultrafiltration, hypoxemia persisted. CTA chest ruled out pulmonary embolism but revealed diffuse peribronchovascular opacities and consolidations. He was subsequently transferred to the ICU for worsening respiratory failure requiring high-flow nasal cannula. The patient’s daughter reported recent exposure to cleaning agents (Simple Green Oxy Solve and Fabuloso) while cleaning in a closed garage. Infectious, autoimmune, and vasculitis workups were negative. Due to impending respiratory failure, he was emergently intubated and underwent bronchoscopy with bronchoalveolar lavage. Further infectious and autoimmune work-up was negative. He was treated empirically with broad-spectrum antibiotics and pulse-dose methylprednisolone for suspected acute chemical pneumonitis. His respiratory status improved rapidly, allowing for extubation within five days. Follow-up imaging demonstrated marked resolution of infiltrates, and he was discharged on a prednisone taper with outpatient pulmonary follow-up. Discussion This case underscores a preventable and underrecognized source of acute lung injury arising from common household cleaning products. Hydrogen peroxide–based and surfactant-containing cleaners can generate reactive oxygen species and volatile organic compounds, leading to oxidative alveolar injury and epithelial barrier disruption. The resulting pathophysiology mirrors features of diffuse alveolar damage seen in acute respiratory distress syndrome (ARDS). Clinically, distinguishing chemical pneumonitis from infection or cardiogenic edema requires a high index of suspicion and exposure history. Corticosteroids mitigate inflammation and prevent progression to fibrosis when administered early in confirmed noninfectious injury. The patient’s improvement following high-dose steroids aligns with prior reports suggesting therapeutic benefit. From a public health standpoint, inhalational injury from cleaning agents remains largely underreported despite growing prevalence. This case emphasizes the importance of patient education, proper ventilation, and awareness of environmental exposures in evaluating acute hypoxemic respiratory failure. This abstract is funded by: None