Lungs Ablaze: An Unusual Case of Aspiration Pneumonitis.

SESSION TITLE: Miscellaneous Cases ISESSION TYPE: Affiliate Case Report SlidePRESENTED ON: Sunday, October 26, 2014 at 10:45 AM - 12:00 PMINTRODUCTION: We present a case of hydrocarbon pneumonitis secondary to aspiration of tiki torch fluid.

CASE PRESENTATION: A 19 year old healthy female presented with dyspnea,pleurisy & drenching night sweats,post ingestion of "tiki" (flame) torch fluid,while inebriated at a party.Physical exam showed a room air oxyhemoglobin saturation of 88% & diminished bibasilar breath sounds.Computed tomography of the chest revealed bilateral effusions & consolidations.Empiric ampicillin-sulbactam was started.Pleural ultrasonography & fluid analysis revealed a complicated pleural space with a hemorrhagic,lymphocyte predominant exudate,refractory to drainage.Bronchoalveolar lavage samples were culture negative.Oil-Red-O stain was positive for lipid in macrophages.After 4 days the patient had continued symptoms.A trial of steroids was initiated with dramatic clinical improvement.She was discharged off oxygen,on oral antibiotics & prednisone.At follow up she had minimal symptoms with near complete resolution of her effusions.She completed a 6 week antibiotic course & steroids were tapered gradually.She was lost to further follow up.DISCUSSION: Tiki flame torches,popularly associated with Polynesian themed art use hydrocarbon fuels."Fire-eater's pneumonia",is a distinct type of acute chemical pneumonitis & exogenous lipoid pneumonia from aspiration of liquid hydrocarbons by flame blowing entertainers.These substances rapidly diffuse through the bronchial tree & disrupt the surfactant barrier.Activation of macrophages leads to a dramatic release of inflammatory cytokines.Radiographic changes include ground glass opacities,consolidations,poorly marginated nodules,pneumatoceles,pneumomediastinum,pneumothorax,pleural effusions & areas of hypoattenuation consistent with fat within consolidations.Use of empiric antibiotics & steroids is controversial.Most patients make a complete recovery.In our patient severe pleural space involvement led to antibiotic use.However,rapid improvement was observed only after the initiation of corticosteroids.

CONCLUSIONS: Exposure to flame torch fuel, leading to the uncommon clinical picture of "fire-eaters lung" can occur in atypical settings.Care is supportive & should include a search for superimposed infections.The use of steroids can be considered on a case by case basis. Reference #1: Betancourt SL,et al.Lipoid pneumonia:spectrum of clinical and radiological manifestations.Am J Roentgen.2010;194:103-109.Reference #2: Gentina T,et al.Fire- eaters lung:seventeen cases and review of literature.Medicine.2001;80:291-297Reference #3: .DISCLOSURE: The following authors have nothing to disclose: Rajesh Zacharias, Michael Colancecco, Ryan Shipe, Stephen Summers, Paulo Oliveira, Bruce Greenberg, Andrew FischerNo Product/Research Disclosure Information.