A 65-Year-Old Man with Pulmonary Opacities and Worsening Cough

Our plain-English summary of A 65-Year-Old Man with Pulmonary Opacities and Worsening Cough, by W. Pidcock, F. Chau-Etchapare, S. Murin (Chest, 2019).

The study

• Authors: W. Pidcock, F. Chau-Etchapare, S. Murin
• Journal: Chest
• Published: 2019;156(6):e117-e120
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 65-year-old man was referred for evaluation of several years of chest congestion and cough productive of yellow sputum as well as recently noted abnormalities on chest imaging. He denied dyspnea, weight loss, fevers, chills, or hemoptysis. He had no history of systemic illness, pneumonia, other respiratory illness, gastroesophageal reflux, or sinusitis. He had a remote smoking history. He worked as a railroad conductor and had occupational exposure to asbestos, as well as to other uncharacterized dusts and fumes. The patient spent most of his life in Washington and California and regularly traveled through the California Central Valley. Other travel history included trips to Southeast Asia, Iceland, and Europe in the remote past. The patient had one dog but no exposure to other animals. His only medication was loratadine, taken daily for allergic rhinitis. He applied petroleum jelly to his nares nightly to moisturize his nasal passages.

Copyright © 2019. Published by Elsevier Inc.

In plain English

This case report describes a 65-year-old man, a railroad conductor with occupational exposure to asbestos and to other uncharacterized dusts and fumes. For several years he had chest congestion and a cough producing yellow sputum. The patient had a remote smoking history and applied petroleum jelly inside the nose every night. A chest CT scan showed a fat-density nodule in the right lower lobe, which the radiologist suspected was a hamartoma, a benign growth. It also showed opacities in both lower lobes, the right middle lobe and the lingula. In the lower lobes these opacities measured minus 92.1 to minus 32.7 Hounsfield units, a negative density reading. Fluid washed from the right lower lobe during bronchoscopy contained lipid-laden macrophages and no malignant cells, and cultures grew Mycobacterium chelonae. The diagnosis was lipoid pneumonia caused by chronic aspiration of petroleum jelly, complicated by M chelonae infection. The diagnosis did not involve asbestos, and the article does not discuss the asbestos exposure further. The patient stopped using petroleum products and was treated for 6 months with clarithromycin and ertapenem. Symptoms and imaging markedly improved. The authors concluded that all patients with suspected lipoid pneumonia should have specimens sent for acid-fast bacteria culture.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient, published as a clinical teaching case)
• Who was studied: one 65-year-old man, a railroad conductor with occupational asbestos exposure and a remote smoking history, who had lived mostly in Washington and California
• Exposure: nightly application of petroleum jelly to the nostrils, which the authors identified as the cause of the lung disease; occupational asbestos and other dust and fume exposure was also recorded in the history
• Main results:
  • CT showed a rounded, noncalcified nodule in the right lower lobe with the density of fat, suspected by the radiologist to be a hamartoma
  • Peribronchovascular opacities in the lower lobes measured minus 92.1 to minus 32.7 Hounsfield units
  • Bronchoscopic lavage of the right lower lobe showed lipid-laden macrophages, foreign material and bacterial aggregates, and no malignant cells
  • Acid-fast bacteria cultures from the patient grew Mycobacterium chelonae
  • Diagnosis: lipoid pneumonia from chronic petroleum jelly aspiration, complicated by Mycobacterium chelonae infection
  • After stopping petroleum products and 6 months of clarithromycin and ertapenem, the patient's symptoms and imaging markedly improved
• The authors' conclusion: The authors concluded that all patients with diagnosed or suspected lipoid pneumonia should have specimens sent for acid-fast bacteria culture, because nontuberculous mycobacterial superinfection can occur

Topics

Medical terms in this study, explained in our Lexicon: Sputum, Dyspnea, Hemoptysis, Occupational Exposure.

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