长期应用复方薄荷脑滴鼻液导致外源性脂质性肺炎1例
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摘要
<正>外源性脂质性肺炎(exogenous lipoid pneumonia,ELP)是由于脂类物质吸入后在肺内的异常沉积所发生的肺部少见疾病,临床表现不特异,容易被误诊为间质性肺炎和肺癌。从既往的临床经验和病例报道来看,该病多见于存在误吸高风险的人群,如精神异常、吞咽和胃肠功能障碍的老年人,其中以因肠梗阻、慢性便秘而使用液体石蜡作为通便药时发生
Here we reported a case of exogenous lipoid pneumonia from Peking University Third Hospital. A 62-year-old male presented with chronic cough and expectoration for 8 years,without chest pain,hemoptysis or short of breath. He was an ex-smoker. In his past medical history,the patient reported chronic rhinitis sicca for 20 years. Chest computed tomography( CT) showed patchy ground glass opacities in his bilateral lower lobe. In recent 3 years,his symptoms showed slowly deteriorative changes,as did his chest CT findings. No improvement of the patient's symptoms was observed,although he had been treated with many antibiotics. Then he was referred to our hospital for a detailed investigation for interstitial lung disease. On admission,the physical examination showed no abnormal findings except for inspiratory fine crackles in his bilateral lower lung field on auscultation. The results of the laboratory analysis,including complete blood cell count,biochemistry,arterial blood gas,urinalysis,antinuclear antibody( ANA),antineutrophil cytoplasmic antibody( ANCA) and tumor markers were all within normal ranges. To exclude the possibility of infectious or malignant conditions,bronchoscopy was performed. Secretions from the left lower lobe bronchus were collected for bacterial,fungal and fast-acid cultures,which were all negative. A bronchoalveolar lavage( BAL) was performed in the left lower lobe with a 30% recovery. The total cell count of the BAL fluid was 6. 5 × 104/m L,and the cellularity differential revealed increased neutrophils( 20%) and lymphocytes( 17%). The cytological examination in the BAL fluid showed no malignant cells. All the clinical data above did not reveal any conclusive information. However,the pathological findings of his transbronchial lung biopsy( TBLB) were highlighted with lipid-laden macrophages engulfed by large vacuoles occupying almost completely the cytoplasm of the cells,which were consistent with those of exogenous lipoid pneumonia. Given these findings,it emerged that the patient was taking twice daily inhalations of a compound menthol nasal drops( essential oil of camphor,menthol and liquid paraffin) for his chronic rhinitis sicca for at least 10 years. Then he discontinued oil nasal sprays and showed gradual improvement 3 months later without intensive treatment. The presenting case report emphasizes the fact that chronic inhalation of nasal sprays and decongestants containing mineral oils was a cause of exogenous lipoid pneumonia,and clinicians should bear it in mind.
Here we reported a case of exogenous lipoid pneumonia from Peking University Third Hospital. A 62-year-old male presented with chronic cough and expectoration for 8 years,without chest pain,hemoptysis or short of breath. He was an ex-smoker. In his past medical history,the patient reported chronic rhinitis sicca for 20 years. Chest computed tomography( CT) showed patchy ground glass opacities in his bilateral lower lobe. In recent 3 years,his symptoms showed slowly deteriorative changes,as did his chest CT findings. No improvement of the patient's symptoms was observed,although he had been treated with many antibiotics. Then he was referred to our hospital for a detailed investigation for interstitial lung disease. On admission,the physical examination showed no abnormal findings except for inspiratory fine crackles in his bilateral lower lung field on auscultation. The results of the laboratory analysis,including complete blood cell count,biochemistry,arterial blood gas,urinalysis,antinuclear antibody( ANA),antineutrophil cytoplasmic antibody( ANCA) and tumor markers were all within normal ranges. To exclude the possibility of infectious or malignant conditions,bronchoscopy was performed. Secretions from the left lower lobe bronchus were collected for bacterial,fungal and fast-acid cultures,which were all negative. A bronchoalveolar lavage( BAL) was performed in the left lower lobe with a 30% recovery. The total cell count of the BAL fluid was 6. 5 × 104/m L,and the cellularity differential revealed increased neutrophils( 20%) and lymphocytes( 17%). The cytological examination in the BAL fluid showed no malignant cells. All the clinical data above did not reveal any conclusive information. However,the pathological findings of his transbronchial lung biopsy( TBLB) were highlighted with lipid-laden macrophages engulfed by large vacuoles occupying almost completely the cytoplasm of the cells,which were consistent with those of exogenous lipoid pneumonia. Given these findings,it emerged that the patient was taking twice daily inhalations of a compound menthol nasal drops( essential oil of camphor,menthol and liquid paraffin) for his chronic rhinitis sicca for at least 10 years. Then he discontinued oil nasal sprays and showed gradual improvement 3 months later without intensive treatment. The presenting case report emphasizes the fact that chronic inhalation of nasal sprays and decongestants containing mineral oils was a cause of exogenous lipoid pneumonia,and clinicians should bear it in mind.
引文
[1]Gondouin A,Manzoni P,Ranfaing E,et al.Exogenous lipid pneumonia:a retrospective multicentre study of 44 cases in France[J].Eur Respir J,1996,9(7):1463-1469.
[2]Laughlen GF.Studies on pneumonia following nasopharyngeal injection of oil[J].Am J Pathol,1925,1(4):407-414.
[3]石玉琪,许春芳.长期应用油性滴鼻剂致外源性脂质性肺炎1例报告[J].中国实用内科杂志,2015,35(8):719-721.
[4]谭政,许小毛,杨菁菁,等.老年人外源性类脂质肺炎14例[J].中华老年医学杂志,2016,35(11):1187-1191.
[5]Brown AC,Slocum PC,Putthoff SL,et al.Exogenous lipoid pneumonia due to nasal application of petroleum jelly[J].Chest,1994,105(3):968-969.
[6]Betancourt SL,Martinez-Jimenez S,Rossi SE,et al.Lipoid pneumonia:spectrum of clinical and radiologic manifestations[J].Am J Roentgenol,2010,194(1):103-109.
[2]Laughlen GF.Studies on pneumonia following nasopharyngeal injection of oil[J].Am J Pathol,1925,1(4):407-414.
[3]石玉琪,许春芳.长期应用油性滴鼻剂致外源性脂质性肺炎1例报告[J].中国实用内科杂志,2015,35(8):719-721.
[4]谭政,许小毛,杨菁菁,等.老年人外源性类脂质肺炎14例[J].中华老年医学杂志,2016,35(11):1187-1191.
[5]Brown AC,Slocum PC,Putthoff SL,et al.Exogenous lipoid pneumonia due to nasal application of petroleum jelly[J].Chest,1994,105(3):968-969.
[6]Betancourt SL,Martinez-Jimenez S,Rossi SE,et al.Lipoid pneumonia:spectrum of clinical and radiologic manifestations[J].Am J Roentgenol,2010,194(1):103-109.