Presentation
Long-standing dyspnea with unremarkable blood tests. Restrictive pulmonary disease on the pulmonary functional test.
Patient Data
no pericardial or pleural effusion
ground glass opacifications in the lung bases with subpleural reticulations
interlobular septal thickening in the right S7 segment, with ground glass opacification in keeping with a crazy paving pattern
no lung architectural distortion
subpleural nodule in the left S9 segment
The features are those of interstitial lung disease.
The chest x-ray is unremarkable.
There is no significant interval evolution, the lesions did not regress and are stable after one year.
The initial diagnosis of interstitial lung disease of undetermined origin was made.
Bronchoscopy was unremarkable.
A bronchoalveolar lavage was performed demonstrating:
8% of macrophages with a clear cytoplasm
80% activated small to medium-sized lymphocytes
2% eosinophils
presence of some mastocytes
The patient did not have history of exposure to allergens (she had no animals, no gardening), not exposed to smoke.
No history of allergy, connective tissue disease, cancer, hepatic or cardiac disease.
The medications she was taking regularly were: irbesartan (for high blood pressure), levothyroxine, NSAIDs, beclometasone, macrogol and paraffin (for chronic constipation).
There is no evolution after two years, and all lesions are stable.
Case Discussion
The diagnosis of lipoid pneumonia was made out of the association of interstitial lung disease with lymphocytosis (on bronchoalveolar lavage) and paraffin intake.
The patient took paraffin for constipation, and it was chronically inhaled due to concomitant gastro-esophageal reflux disease.
The treatment was to stop paraffin intake, no other specific treatment was advised.
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