Exogenous Lipoid Pneumonia Complicated with Mycobacterium fortuitum Infection

Abstract

Background. Exogenous lipoid pneumonia (ELP) is a rare disorder caused by the aspiration or inhalation of fat or oil. We report a case of vegetable oil-induced ELP complicated with Mycobacterium fortuitum infection. Case Report. An 82-year-old woman underwent radiation therapy for carcinoma of the maxillary sinus. Seven months later, she was referred to our hospital for evaluation of persistent cough and abnormal chest roentgenogram. She underwent fiberoptic bronchoscopy with bronchoalveolar lavage (BAL). The BAL fluid separated into 2 distinct layers, an upper yellowish layer and a lower aqueous layer, containing a large number of vacuolated macrophages, and was positive for M. fortuitum. We subsequently found that the patient had regularly consumed a nutritional product, consisting mostly of vegetable oil, for dry mouth caused by radiation therapy. She was placed on antimicrobial and corticosteroid therapy but with little relief. Conclusion. Aspiration of vegetable oil used for radiation therapy-induced xerostomia caused ELP superimposed with M. fortuitum infection. Lipids in alveoli might have pathogenetic effects on mycobacterial infection.