Shark Oil Pneumonia: An Overlooked Entity

doi:10.1378/chest.103.3.976

Chest

Volume 103, Issue 3, March 1993, Pages 976-977

https://doi.org/10.1378/chest.103.3.976 Get rights and content

Nonprescription drugs are often believed to be innocuous. We present a case of lipoid pneumonia from ingestion of squalene, a derivative of shark liver oil, a popular over-the-counter Asian folk remedy.

Section snippets

CASE REPORT

A 46-year-old hypertensive Korean man was admitted to Flushing Hospital complaining of three days of progressive left facial and extremity weakness. He denied taking any medications.

On physical examination, the only abnormal finding was a dense left hemiplegia with a left central facial nerve paralysis.

Laboratory studies at the time of hospital admission included a normal complete blood cell count, electrolytes, and urinalysis. The aspartate aminotransferase was 67 U/L, alanine aminotransferase

DISCUSSION

Lipoid pneumonia is divided into endogenous and exogenous forms. In the case of endogenous (cholesterol) pneumonia, the fatty materials are derived from the lung itself as in malignant obstructing bronchial tumors or bronchiectasis. In the more commonplace exogenous lipoid pneumonia, lipids enter the lung parenchyma as a result of aspiration.³ The effects on the lung are primarily related to the content of fatty acid: vegetable oils such as poppyseed and sesame produce little if any pulmonary

ACKNOWLEDGMENTS

We would like to thank Mr. Jack Rush, BPA, our photographer, and Dr. Nak Chin Chung for his kind referral.

REFERENCES (5)

RH Sundberg et al.
Evaluation of lipoid pneumonia
Dis Chest
(1959)
GF Laughlin
Studies of pneumonia following naso-pharyngeal injections of oil
Am J Pathol
(1925)

There are more references available in the full text version of this article.

Cited by (26)

Functional and Nutraceutical Ingredients From Marine Resources
2019, Value-Added Ingredients and Enrichments of Beverages: Volume 14: The Science of Beverages
Marine environment harbors a plethora of bioactive components having huge functional and nutraceutical potential. Several bioactive ingredients from marine ecosystem have already entered beverage market as functional and medicinal supplements. These are primarily, fish oil, proteins and peptides, chitins, pigments, taurine, squalene, proteoglycans, polyphenols, probiotics, polysaccharides, vitamins, and minerals. These bioactive molecules provide innumerable health benefits, including antioxidant, antiarthritic, antihypertensive, antibacterial, anticarcinogenic, antiobese, and antiinflammatory activities. Apart from the main-stream capture resource, the huge quantities of process discards generated at seafood processing industries capitulate a number of recoverable functional and nutraceutical compounds. In this chapter, a comprehensive note on the major bioactives is provided covering a discussion on their general characteristics, potential sources, and nutraceutical and functional properties with emphasis on their use as potential ingredients in beverage formulations.
Exogenous lipid pneumonia in old people caused by aspiration: Two case reports and literature review
2019, Respiratory Medicine Case Reports
Citation Excerpt :
All 25 cases are presented in Table 1. ELP is an uncommon form of pneumonia related to the aspiration of lipid containing substances, such as petroleum jelly, mineral oil laxatives, oil based nasal drops, milk, poppy seed oil, and egg yolk [17,25]. It is characterized by a chronic foreign body-type reaction to inhaled exogenous lipid droplets on histologic specimens [26,27].
Exogenous lipoid pneumonia is a rare entity, the diagnosis is often missed or delayed.
To investigate the clinical characteristics of exogenous lipid pneumonia in elderly patients, improve the efficiency of early diagnosis and treatment of this disease.
Retrospectively analyzed the clinical information and imaging data of these 2 exogenous lipid pneumonia patients, reviewed related literature.
Both of the 2 patients were over 60 with a history of gastrointestinal diseases. The clinical presentation is nonspecific. Chest CT showed many different manifestations. Histopathology analysis revealed the accumulation of lipid carrying macrophages, vacuolar cells and inflammation. A literature review indicated that 25 previous cases of exogenous lipid pneumonia were caused by aspiration. The most common site of the lesion was located in right lung, while mineral oil was the most common substances. We sought to discuss the patient's treatment and the corresponding outcomes.
The diagnosis of lipid pneumonia's mainly depends on medical history and histopathological morphology. The standard treatment for exogenous lipid pneumonia was composed of antibiotics, steroid, bronchoscopic lavage and a regular follow-up.
A case of lipoid pneumonia caused by inhalation of vaporized paraffin from burning candles
2016, Respiratory Medicine Case Reports
Citation Excerpt :
Subsequently, improvement in the chest radiograph findings without additional therapy was observed again, and the patient remained in remission. Lipoid pneumonia is an uncommon non-infectious, inflammatory disease resulting from aspiration or inhalation of fat-like compounds from animal, vegetable, or mineral oil [1,2]. It is caused by the accumulation of macrophages that phagocytize the lipids in the intra-alveolar spaces.
A 66-year-old woman was referred to our hospital for investigation of interstitial lung disease. She had spent most of her time in a shrine, and had always been exposed to vaporized paraffin from burning candles. Chest High-resolution computed tomography (HRCT)showed ground-glass attenuation with thickening of septal lines, wh create the so-called “crazy-paving appearance”. Although bronchoalveolar lavage(BAL) and transbronchial biopsy were performed to aid in diagnosis, the findings did not reveal any conclusive information. Improvements on chest radiographs and in the patient's symptoms were observed without any therapeutic intervention; however, one year later, her chest X-ray showed deteriorative changes. Surgical lung biopsy was performed, and the pathological findings were consistent with those of lipoid pneumonia. The patient showed spontaneous remission of the disease. The cause of exogenous lipoid pneumonia was attributed to inhalation of vaporized paraffin from burning candles in the shrine.
This is the first case of lipoid pneumonia that was found to develop from exposure to vaporized paraffin.
Exogenous lipoid pneumonia. Clinical and radiological manifestations
2011, Respiratory Medicine
Citation Excerpt :
Cytological examination may be negative despite chemical evidence in the sputum of oil expectoration.6 On the failure of other methods, open lung biopsy may be indicated, with the disadvantage of being a much more invasive procedure.9,14 If the diagnosis remains uncertain, percutaneous fine-needle aspiration biopsy, transbronchial biopsy or open lung biopsy may be necessary.46
Lipoid pneumonia results from the pulmonary accumulation of endogenous or exogenous lipids. Host tissue reactions to the inhaled substances differ according to their chemical characteristics. Symptoms can vary significantly among individuals, ranging from asymptomatic to severe, life-threatening disease. Acute, sometimes fatal, cases can occur, but the disease is usually indolent. Possible complications include superinfection by nontuberculous mycobacteria, pulmonary fibrosis, respiratory insufficiency, cor pulmonale, and hypercalcemia. The radiological findings are nonspecific, and the disease presents with variable patterns and distribution. For this reason, lipoid pneumonia may mimic many other diseases. The diagnosis of exogenous lipoid pneumonia is based on a history of exposure to oil, characteristic radiological findings, and the presence of lipid-laden macrophages on sputum or BAL analysis. High-resolution computed tomography (HRCT) is the best imaging modality for the diagnosis of lipoid pneumonia. The most characteristic CT finding in LP is the presence of negative attenuation values within areas of consolidation. There are currently no studies in the literature that define the best therapeutic option. However, there is a consensus that the key measure is identifying and discontinuing exposure to the offending agent. Treatment in patients without clinical symptoms remains controversial, but in patients with diffuse pulmonary damage, aggressive therapies have been reported. They include whole lung lavage, systemic corticosteroids, and thoracoscopy with surgical debridement.
The diagnosis of exogenous lipoid pneumonia caused by the silent aspiration of vegetable oil using a lipidomic analysis
2020, Internal Medicine
A case of foreign body granuloma after squalene injection by non-dermatologists
2016, Korean Journal of Dermatology

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Chest

Selected ReportsShark Oil Pneumonia: An Overlooked Entity

Section snippets

CASE REPORT

DISCUSSION

ACKNOWLEDGMENTS

Dis Chest

Studies of pneumonia following naso-pharyngeal injections of oil

Am J Pathol

Selected Reports
Shark Oil Pneumonia: An Overlooked Entity