Pneumatocele complicating acute hydrocarbon pneumonitis

Massive Gasoline Ingestion in a 64-Year-Old Female: An Explosive Situation

Hydrocarbons from gasoline are toxins that can affect a multitude of organ systems based on the route of chemical intoxication exposure, with a majority involving oral ingestion or inhalation. Data is still incomplete concerning the systemic complications of gasoline ingestion due in part to variability in the chemical composition of various gasoline products.

A 64-year-old female presented to her local emergency department following the ingestion of gasoline in a suicide attempt with altered mental status, hypotension, shortness of breath, tachypnea, sinus tachycardia, coarse rhonchi bilaterally, and hyperactive bowel sounds. Treatment upon admission included intravenous ampicillin/sulbactam, intubation, an intravenous fluid bolus, and ketamine to address the developing hypotension. The patient developed multiorgan failure and acute toxic encephalopathy despite medical interventions and hemodialysis. After four days, comfort care measures were initiated, and the patient passed away.

Gasoline toxicity can have a profound effect on multiple organs based on the chemical properties and the route of exposure. These sequelae can be monitored through patient symptoms as well as radiologic imaging. Early supportive therapy and decontamination are vital in decreasing the morbidity and mortality associated with gasoline ingestion.

Lipoid pneumonitis in a patient with an accidental ingestion of kerosene successfully treated with bronchoscopic segmental lavage and systemic steroid: Case report

RATIONALE

Standard treatment of lipoid pneumonitis remains unclear. This study reports a case of kerosene pneumonitis successfully treated with systemic steroid and segmental bronchoalveolar lavage (BAL).

PATIENT CONCERNS

A 30-year-old woman referred to our hospital because of worsening of respiratory symptoms and fever despite antibiotic therapy following accidental ingestion of kerosene. She had no underlying disease.

DIAGNOSES

Chest CT scan showed necrotic consolidation, ground glass opacity (GGO), bronchial wall thickening in the right middle/lower lobe (RML/RLL) and right pleural effusion. The lipoid pneumonitis was confirmed by identification of a lipid laden macrophage in bronchoalveolar lavage fluid.

INTERVENTIONS

The patient was treated with systemic corticosteroid and segmental BAL.

OUTCOMES

The patient's symptoms rapidly improved after treatment and she was discharged one week after admission. A follow-up CT scan a week after discharge revealed marked resolution of consolidation. No recurrence was reported for 8 months.

LESSONS

This is the first case of kerosene pneumonitis successfully treated with systemic steroid and bronchoscopic segmental lavage therapy in Korea. Very few cases have been reported worldwide.