Abstract

Exogenous lipoid pneumonia is an uncommon condition resulting from aspiration or inhalation of fat-containing material. Oil-based laxatives such as liquid paraffin and aerosolised oils are most commonly implicated. These substances ellicit a foreign body reaction and proloferative fibrosis in the lung.

We descibe 2 patients with exogenous lipoid pneumonia in whom clinical history confirmed heavy long-term use of Vicks Vaporub as the causative agent.

Other features of these cases are:

Patient 1 is a 56 year old poorly controlled epileptic, whose mother regularly applied Vicks Vaporub into each nostril during grand mal seizures. She is asymptomatic but a diffuse fine reticulo-nodular pattern was an incidental finding on routine chest X-ray. Further observations confirmed cyanosis, diffuse bi-basal crackles, type 2 respiratory failure, and early features of cor pulmonale. Pulmonary function showed moderate obstruction and the CO-transfer factor was 40% predicted. Transbronchial biopsy showed features of lipoid pneumonia with excessive fibrosis. The patient refused treatment.

Patient 2 was a diebetic who presented with a 4 month history of cough productive of white sputum and worsening shortness of breath. No history of other respiratory illness or any exposure history was obtained. Bibisal late inspiratory crackles were audible. CXR showed a bilateral reticular infiltrate. Pulmonary function tests showed a mild restrictive defect with a CO-transfer factor 30% predicted. Transbronchial biopsy revealed foreign body granulomara with fibrosis and foamy histiocytes. She was treated with prednisone but continued to deteriorate, developed cor pulmonale and respiratory failure and died after 36 months.

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