A Case of Lipoid Pneumonia Determined Attributed to Gastroesophageal Reflux Based on Dynamic Observation with Bronchoscopy

Abstract

Background. Lipoid pneumonia is a type of pneumonia characterized by the presence of fat-phagocytic macrophages in the lungs. It can be caused by numerous factors, such as airway obstruction from tumors and gastroesophageal reflux disease. Case. An 80-year-old man with ALK-positive lung adenocarcinoma underwent surgery and was receiving alectinib for postoperative recurrence. He developed a productive cough, and computed tomography revealed ground-glass opacity in the S² of the right lung. The possibility of drug-induced pneumonia or aspiration pneumonia was considered, and despite discontinuing alectinib and administering antibiotics, there was no improvement. During bronchoscopy, it was observed that digestive fluid was dripping into the right lung B², and lipophagocytic macrophages were found in the bronchoalveolar lavage fluid. He was diagnosed with lipoid pneumonia caused by gastroesophageal reflux. After receiving steroid treatment, the opacity in his lungs disappeared. Conclusions. The observation of digestive fluid dripping into the affected bronchus during bronchoscopy was crucial in identifying the cause of lipoid pneumonia. When performing bronchoscopy, we should be alert for dynamic phenomena in the airways.