Lipoid pneumonia: A silent complication of mineral oil aspiration

Introduction. Chronic constipation is a common symptom in pediatrics, and p hysicians often use mineral oil to treat chronic constipation in children. Mineral oil, a hydrocarbon, may not elicit a normal protective cough reflex and may impair mucociliary transport. These effects can increase the likel ihood of its aspiration and subsequent impaired clearance from the respirat ory tract. We report a case of a child with neurodevelopmental delay with c hronic constipation and a history of chronic mineral oil ingestion presenti ng as asymptomatic exogenous lipoid pneumonia (ELP). Case History. A 6-year-old white boy with a history of developmental delay was found to have an infiltrate in his right upper lobe on a chest radiogra ph obtained during evaluation for thoracic scoliosis. The patient had a lon g history of constipation with daily use of mineral oil. He was fed by mout h and had occasional episodes of coughing and choking during feeding. He wa s asymptomatic at presentation and physical examination was unremarkable. T he patient was advised to stop administration of the mineral oil and was tr eated empirically with antibiotics during a 3-month period. At follow-up ex amination the patient continued to be asymptomatic, with the radiologic per sistence of the infiltrate. Diagnosis of lipoid pneumonia was made by diagn ostic bronchoscopy with bronchoalveolar lavage (BAL). The exogenous origin of the lipid in the BAL fluid was confirmed by gas chromatography/mass spec trometry. Discussion. The clinical presentation of ELF is nonspecific and ranges from the totally asymptomatic patient with incidental radiologic finding, like our patient, to the patient with acute or chronic symptoms attributable to pneumonia, pulmonary fibrosis, or cor pulmonale. Bronchoscopy with BAL can be successful in establishing the diagnosis of ELF by demonstration of a hi gh lipid-laden macrophage index. Treatment of ELF in children is generally supportive, with the symptoms and roentgenographic abnormalities resolving within months after stopping the use of mineral oil. Conclusion. Lipoid pneumonia as a result of mineral oil aspiration still oc curs in the pediatric population. It can mimic other diseases because of it s nonspecific clinical presentation and radiographic signs. In patients wit h swallowing dysfunction and pneumonia, a history of mineral oil use should be obtained and a diagnosis of ELF should be considered in the differentia l diagnoses if mineral oil use has occurred. Our case points to the need fo r increased awareness by the general pediatricians of the potential hazards of mineral oil use for chronic constipation.