A42-05 A Slick Encounter With Lipoid Pneumonia: Articulating the Complexities of a Rare Condition

Abstract Background Lipoid pneumonia is a rare inflammatory response to lipid accumulation in the lung associated with aspiration risk factors such as neurologic disease or swallowing dysfunction. We present a case of grade three exogenous lipoid pneumonia in a patient without classic predispositions and autoimmune history, who developed progressive disease following corticosteroid taper. Case Report A 40-year-old woman with juvenile rheumatoid arthritis, anxiety, and posttraumatic stress disorder presented with progressive dyspnea. She had been hospitalized two weeks earlier for worsening dyspnea and treated empirically with intravenous antibiotics for suspected pneumonia, with temporary improvement.On current admission, oxygen saturation was in the 80s on room air, requiring 1-2 L of nasal cannula oxygen. Computed tomography of the chest revealed multifocal ground-glass and consolidative opacities, predominantly in the right middle and bilateral lower lobes. Laboratory studies were unremarkable, and infectious testing including respiratory PCR was negative. She was treated with empiric antibiotics and systemic steroids.Bronchoscopy demonstrated turbid bronchoalveolar lavage(BAL) fluid. Cytology confirmed grade three lipid-laden macrophages on Oil Red O staining. BAL PCR was negative. On further assessment, the patient reported chronic ingestion of mineral oil for constipation over two years and recent inhalation of essential oils. Antibiotics were discontinued, and she was discharged on a prednisone taper from 40 mg to 10 mg over 12 days, atorvastatin 40 mg daily, and strict cessation of mineral oil. At one-month follow-up, CT imaging showed progression of ground-glass and consolidative opacities. At two months, she continued to require 2 L oxygen with exertion and reported ongoing cough with sputum production. Discussion Presentation of lipoid pneumonia typically includes cough, dyspnea, and occasionally fever(1). Diagnosis relies on history of exposures, imaging, and BAL demonstrating lipid-laden macrophages. First described in 1925 in animal models and later on autopsies of patients using oil-based laxatives and nasal drops(2,3), it remains rare. Radiographic findings are nonspecific, often showing ground-glass opacities, consolidation, or interlobular thickening(3).Chronic mineral oil aspiration leads to alveolar lipid accumulation, inflammation, and fibrosis. Management centers on discontinuation of the offending agent. Corticosteroid use has been described in case reports and small series, with variable tapering regimens(4). This patient is being treated with atorvastatin, a novel therapy; statins have been shown to have anti-oxidant benefits by downregulating pro-inflammatory cytokines and modulating immune cellular functions(5). Despite its rarity, standardized treatment guidelines are needed, particularly for patients requiring ventilatory support(6). This abstract is funded by: None