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Lipoid pneumonia in infants: treatment with multiple bronchoalveolar lavages

Introduction: Lipoid pneumonia (LP) is a non-infectious and uncommon pneumonia related to the inhalation or aspiration of oily substances. In Brazil, it is caused for mineral oil (MO), used mainly in intestinal constipation. Multiple bronchoalveolar lavages (MBAL) had been performed in order to clean the oil aspirated from the lung parenchyma. Objective: To evaluate the effectiveness of MBAL as a therapeutic strategy in clinical and laboratory recovery of LP. Methodology: Observational, retrospective (2006-2019) study of LP in infants. Medical records and database from pediatric bronchoscopy service and hematology and cytology laboratories of Hospital Universitario Antonio Pedro (HUAP, Rio de Janeiro, Brazil) were researched. Results: 25 infants with report of MO aspiration was included, mean age=6,2±5 months. The main symptoms described were: tachypnea (100%), cough (68%), fever and dyspnea (60%). The first BAL showed an opalescent aspect in 76%; mean total cellularity=1357,9±932,3, macrophages=66,2±22,4 and neutrophils=18,1±19,5. Foamy macrophages stained by Sudan or Oil red confirmed the diagnosis in all cases. At the end of the treatment, with an average duration of 19±13,7 weeks, the last BAL was turbid, with average total cellularity=332,4±147,4, macrophages=78,1±12,8 and lymphocytes=14,3±10,2. On average 9±6.9 BAL were performed. All infants had clinical and radiologic resolution. Conclusion: The suspicion of LP becomes important in an infant who used mineral oil and its appropriate treatment with BAL provides clinical and laboratory resolution, avoiding sequels such as bronchiectasis and pulmonary fibrosis.