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Advances in Respiratory Medicine is published by MDPI from Volume 90 Issue 4 (2022). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Via Medica.
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Case Report

Lipoid Pneumonia—A Case of Refractory Pneumonia in a Child Treated with Ketogenic Diet

by
Piotr Buda
1,*,
Anna Wieteska-Klimczak
1,
Anna Własienko
1,
Agnieszka Mazur
2,
Jerzy Ziołkowski
2,
Joanna Jaworska
2,
Andrzej Kościesza
3,
Dorota Dunin-Wąsowicz
4 and
Janusz Książyk
1
1
Department of Pediatrics, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland
2
Department of of Pediatric Pneumonology and Allergology, Medical University of Warsaw, 02-091 Warsaw, Poland
3
Department of Radiology, CT Unit, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland
4
Department of Neurology and Epileptology, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland
*
Author to whom correspondence should be addressed.
Adv. Respir. Med. 2013, 81(5), 448-452; https://doi.org/10.5603/ARM.35520
Submission received: 19 November 2012 / Revised: 22 August 2013 / Accepted: 22 August 2013 / Published: 22 August 2013

Abstract

Lipoid pneumonia (LP) is a chronic inflammation of the lung parenchyma with interstitial involvement due to the accumulation of endoge- nous or exogenous lipids. Exogenous LP (ELP) is associated with the aspiration or inhalation of oil present in food, oil-based medications or radiographic contrast media. The clinical manifestations of LP range from asymptomatic cases to severe pulmonary involvement, with respiratory failure and death, according to the quantity and duration of the aspiration. The diagnosis of exogenous lipoid pneumonia is based on a history of exposure to oil and the presence of lipid-laden macrophages on sputum or bronchoalveolar lavage (BAL) analysis. High-resolution computed tomography (HRCT) is the imaging technique of choice for evaluation of patients with suspected LP. The best therapeutic strategy is to remove the oil as early as possible through bronchoscopy with multiple BALs and interruption in the use of mineral oil. Steroid therapy remains controversial, and should be reserved for severe cases. We describe a case of LP due to oil aspiration in 3-year-old girl with intractable epilepsy on ketogenic diet. Diagnostic problems were due to non-specific symptoms that were mimicing serious infectious pneumonia. A high index of suspicion and precise medical history is required in cases of refractory pneumonia and fever unresponsive to conventional therapy. Gastroesophageal reflux and a risk of aspiration may be regarded as relative contraindications to the ketogenic diet. Conservative treatment, based on the use of oral steroids, proved to be an efficient therapeutic approach in this case.
Keywords: lipoid pneumonia; refractory pneumonia; ketogenic diet; aspiration; epilepsy lipoid pneumonia; refractory pneumonia; ketogenic diet; aspiration; epilepsy

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MDPI and ACS Style

Buda, P.; Wieteska-Klimczak, A.; Własienko, A.; Mazur, A.; Ziołkowski, J.; Jaworska, J.; Kościesza, A.; Dunin-Wąsowicz, D.; Książyk, J. Lipoid Pneumonia—A Case of Refractory Pneumonia in a Child Treated with Ketogenic Diet. Adv. Respir. Med. 2013, 81, 448-452. https://doi.org/10.5603/ARM.35520

AMA Style

Buda P, Wieteska-Klimczak A, Własienko A, Mazur A, Ziołkowski J, Jaworska J, Kościesza A, Dunin-Wąsowicz D, Książyk J. Lipoid Pneumonia—A Case of Refractory Pneumonia in a Child Treated with Ketogenic Diet. Advances in Respiratory Medicine. 2013; 81(5):448-452. https://doi.org/10.5603/ARM.35520

Chicago/Turabian Style

Buda, Piotr, Anna Wieteska-Klimczak, Anna Własienko, Agnieszka Mazur, Jerzy Ziołkowski, Joanna Jaworska, Andrzej Kościesza, Dorota Dunin-Wąsowicz, and Janusz Książyk. 2013. "Lipoid Pneumonia—A Case of Refractory Pneumonia in a Child Treated with Ketogenic Diet" Advances in Respiratory Medicine 81, no. 5: 448-452. https://doi.org/10.5603/ARM.35520

APA Style

Buda, P., Wieteska-Klimczak, A., Własienko, A., Mazur, A., Ziołkowski, J., Jaworska, J., Kościesza, A., Dunin-Wąsowicz, D., & Książyk, J. (2013). Lipoid Pneumonia—A Case of Refractory Pneumonia in a Child Treated with Ketogenic Diet. Advances in Respiratory Medicine, 81(5), 448-452. https://doi.org/10.5603/ARM.35520

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