SHM Converge Scientific Abstract ePoster Gallery-A Wolf in Wolf's Clothing: An Increasingly Common Cause of Pneumonia

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This case describes a 19-year-old woman with asthma and GERD who presented with fever, cough, dyspnea, pleuritic chest pain, malaise, hypoxia, leukocytosis, and bilateral multifocal ground-glass opacities on CT, initially treated as severe community-acquired bacterial pneumonia with sepsis. Despite escalating antibiotics from ceftriaxone and azithromycin to piperacillin-tazobactam, she worsened clinically and remained febrile with increasing oxygen needs.<br /><br />Further history revealed daily use of nicotine and marijuana vaping products. Bronchoscopy with bronchoalveolar lavage showed no infectious growth, but cytology demonstrated lipid-laden macrophages, confirming exogenous lipoid (lipophilic) pneumonia, likely related to vaping exposure. Antibiotics were discontinued, and she improved with supportive care alone before discharge with plans for outpatient CT imaging and pulmonary function testing.<br /><br />The report emphasizes that lipoid pneumonia is a rare but increasingly recognized cause of pneumonia, particularly among युवans using vaping products. It can be exogenous, from inhaled or injected lipid substances, or endogenous/iatrogenic. Diagnosis is often delayed because symptoms and imaging closely mimic bacterial or viral pneumonia. Histology typically shows lipid-laden macrophages. Treatment is mainly supportive; steroid use is inconsistent, and evidence for other therapies such as IVIG or whole-lung lavage is limited to case reports.<br /><br />The key clinical takeaway is that clinicians should maintain a high suspicion for lipoid pneumonia in young patients with aggressive, nonresolving pneumonia, especially when there is a history of vaping.

Asset Subtitle

John N. George

Meta Tag

Author List Bahram Dideban, Bhagwan Dass, John N. George, Michael Ladna, Neha Solanky, Nicholas Byers, Nicolas N. Kattan, Nila S. Radhakrishnan, Riley G. Jones

Category Clinical Vignettes

Concept Exogenous Lipoid Pneumonia

Concept Lipid-Laden Macrophages

Concept Supportive Care

Concept E-Cigarette Use

Concept Bronchoalveolar Lavage

Distinguished Non-Finalist

Presenter Organization University of Florida

Presenting Author John N. George

Track Adult

Keywords

lipoid pneumonia

vaping

lipid-laden macrophages

ground-glass opacities

bronchoalveolar lavage

community-acquired pneumonia

hypoxia

marijuana vaping

nicotine vaping

supportive care

Exogenous Lipoid Pneumonia

Lipid-Laden Macrophages

Supportive Care

E-Cigarette Use

Bronchoalveolar Lavage