Severe chemical pneumonitis by vanadium pentoxide responded well to aggressive steroid therapy

The optimal treatment of acute chemical pneumonitis remains controversial. Here we report a healthy man with severe chemical pneumonitis caused by accidental inhalation of vanadium pentoxide. He presented with acute respiratory distress and received aggressive steroid therapy on arrival. Pulmonary symptoms and chest X-ray were improved dramatically the next day. The beneficial effect of steroid therapy for such a critical patient may outweigh the infection risk following inhalation of relative sterile material. We suggest early and aggressive steroid therapy may help shorten the disease course.

Ineffective ventilation in a very low birth weight infant with H-type Tracheoesophageal Fistula with bilateral chemical pneumonitis. A lesson learned

Tracheoesophageal fistula (TEF) with or without associated esophageal atresia (EA) in the neonate is challenging to diagnose and manage its complications like aspiration, respiratory distress, and other associated anomalies. To stabilize, ventilate and prepare for surgical correction, understanding the H-nature of disease and anticipation of problems and their management will improve survival. We present a newborn with tracheoesophageal fistula without atresia from resource-limited settings and lessons we learned from the case.

Mendelson's syndrome complicated by bacterial aspiration pneumonia triggered by right putamen bleeding: A case report

We present the case of an 80-year-old woman with Mendelson's syndrome complicated by bacterial aspiration pneumonia caused by consciousness loss followed by vomiting resulting from putamen bleeding. Her condition worsened rapidly to develop respiratory failure, within a few hours; thereafter, she was intubated. Streptococcus agalactiae and Klebsiella oxytoca were detected from the aspirated sputum sample culture. She was diagnosed with acute respiratory distress syndrome with Mendelson's syndrome complicated by bacterial aspiration pneumonia. Corticosteroid and antibiotic administration improved her condition and led to successful extubation; therefore, these treatment modalities were invaluable. We suggest the clinical considerations for the corticosteroid and antibiotic use in such cases.

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We report a case of Mendelson's syndrome complicated by bacterial aspiration pneumonia.

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Use of steroids and antibiotics in such cases is controversial, however, they were reasonable choice in this case.

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We discussed this debatable issue in this case report.

Chemical pneumonitis by prolonged hydrogen fluoride inhalation

Hydrogen Fluoride (HF) inhalation is one of the industrial accidents. It causes serious damage, although it is quickly recognized. Since hydrofluoric acid leaks are under surveillance by the alarm system, and low concentrations of gas also have a distinctive smell, most accidents occur from exposure in a short period to a large amount of HF. Thus, prolonged exposure to HF is exceedingly rare in a developed country. We report seven cases of chemical pneumonitis due to HF inhalation to share clinical course and prognosis.

Vaping-Associated Lung Injury: A New Cause of Acute Respiratory Failure

E-cigarette-and vaping-associated lung injury (EVALI) is a new diagnosis with at least 2,807 hospitalizations and 68 deaths since 2019. This clinical observation describes one of the first cases of EVALI in a teenager who presented with nic-sick symptoms and developed acute respiratory distress syndrome and pneumomediastinum. The manuscript also reviews the presentation, work-up, recommended management, and proposed etiology of the condition and summarizes recent national vaping regulations enacted to address the EVALI epidemic.

Pulmonary injury associated with spray of a water-based nano-sized waterproofing product: a case study

Background

In most reported cases of lung trauma with water proofing products, volatile organic compounds (VOC) have a prominent role. Here we report on a case involving ten workers exposed to a sprayed product containing nanoparticles in a water solution with only a few percent VOC.

Case presentation

Ten workers suffered from respiratory symptoms following spray impregnation of hardwood furniture using a waterproofing product that contained positively charged fluorinated acrylate copolymer solid cores with a median diameter of 70 nm (1.3 w%) in aqueous suspension with 3.3 w% VOC and 0.3 w% quaternary ammonium. The worker who applied one liter of the product in a wood workshop, using an air mix spray gun, did not report any health complaints. Another worker, who entered the workshop 3 h later and had rolled and smoked two cigarettes, was hospitalized with severe chemical pneumonitis. A chest X-ray (CXR) showed bilateral infiltrative impairment in the lower lobe regions. On the next day a second CXR showed increased patchiness marking in all fields. A high-resolution Computer Tomography (CT)-scan demonstrated extensive bilateral areas of ground-glass opacities predominantly in the lower regions of the upper lobes, the right middle lobe and the apical regions of the lower lobes, compatible with severe chemical pneumonitis. On the following morning, nine workers in an adjacent workplace in the same building, experienced dry cough, chest tightness and substernal pain upon physical exercise. Reconstruction of the spray application in a climate chamber confirmed trimethyl silanol, glycol ethers and fluoroalkenes in the gas phase. Immediately after the spray application, aerosols were observed at a maximum concentration of 6.3 × 10⁴ cm⁻³. Mass concentrations were 0.095 and 10 mg/m³ in the size ranges 5.6-560 nm and 0.22-30 μm, respectively, decreasing to less than 10 μg/m³ in both size ranges after 15 h.

Conclusion

The hospitalized worker had smoked cigarettes contaminated with fluoropolymers which is a plausible explanation for the lung trauma. Respiratory symptoms in the nine workers may be caused by inhalation of particles that became airborne by resuspension from surfaces when workers entered the adjacent workplace the next day. A contribution from VOC appears less likely because measurements and modelling showed that concentrations in the mg/m³ range could have occurred only if the building was assumed to be completely airtight.

Electronic supplementary material

The online version of this article (10.1186/s12995-017-0180-7) contains supplementary material, which is available to authorized users.

Chemical pneumonitis from aspiration of rash protector spray

Within hours of accidental instillation of a popular diaper rash protector spray, a 23 day old male developed severe chemical pneumonitis, acute respiratory failure and pneumomediastinum. Despite optimal ventilatory management, the unconventional use of frequent bronchial saline lavages was necessary to maintain oxygenation and ventilation. The only listed active ingredient, 10% dimethicone was a non-toxic inhalant, but the undisclosed inactive ingredients included mineral oil and balsam of peru which may cause chemical pneumonitis and allergic reactions. This case serves as a warning on OTC product designs and formulations, and cautions us to search beyond the listed active ingredients for potential toxicity.

Acute and subacute chemical-induced lung injuries: HRCT findings

Lung injury caused by chemicals includes bronchitis, bronchiolitis, chemical pneumonitis, pulmonary edema, acute respiratory distress syndrome, organizing pneumonia, hypersensitivity pneumonitis, acute eosinophilic pneumonia, and sarcoid-like granulomatous lung disease. Each chemical induces variable pathophysiology and the situation resembles to the drug induced lung disease. The HRCT features are variable and nonspecific, however HRCT may be useful in the evaluation of the lung injuries and so we should know about HRCT features of lung parenchymal abnormalities caused by chemicals.

Pyopneumothorax following kerosene poisoning

Kerosene poisoning is a common poisoning in India especially in childhood, and clinical spectrum can range from meager chemical pneumonitis to grave complications such as hypoxia, pneumothorax, pneumomediastinum, and emphysema. Pyopneumothorax that may require aggressive management in the form of thoracotomy has not been reported in literature. We hereby report a 22-year young female who had developed series of respiratory complications including pyopneumothorax following ingestion of kerosene with suicidal intent and was treated successfully.