two months of isoniazid, rifampin, pyrazinamide, and ethambutol followed by 4-7 months of isoniazid and rifampin. Side effects are common and can complicate efficacious treatment. Although rare, disseminated tuberculosis is an important
consideration when treating patients from countries with high tuberculosis incidences. Prompt recognition of symptoms, particularly those which manifest late, is crucial for a timely diagnosis and appropriate care.
A 33-YEAR-OLD MALE WITH A HISTORY OF NON-HODGKIN’S LYMPHOMA PRESENTED TO THE HOSPITAL WITH A NON-PRODUCTIVE COUGH AND FEVER: LIPOID PNEUMONIA IN CONTEXT OF COSMETIC OILS Hirrah Sajjad, Michael Almquist, Brad Broussard; Department of Medicine, LSU Health Sciences Center, Lafayette, LA.
Introduction: Lipoid pneumonia is a rare lung disease caused by lipid collections in the bronchial tree which induce an inflammatory response within the alveolar sacs due to lipid accumulation. Etiology of lipoid pneumonia is usually exogenous and is associated with a variety of cosmetic oils, vaping, and certain medications such as amiodarone. 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. The incidence of lipoid pneumonia is the United States is increasing, which is thought to be due to an increase prevalence in vaping and cosmetic oils. Case: A 33-year-old male with non-Hodgkin’s lymphoma presented with a non-productive cough and fever. The patient had recently been hospitalized for similar symptoms. On this admission, he endorsed worsening shortness of breath and increased frequency of cough. Initial laboratory work-up was largely unremarkable. A CTA of the thorax was performed for further evaluation of his shortness of breath which showed ground
glass and air space opacities seen in left and right lower lobe. A bronchoscopy was performed with BAL and the pathology specimen showed intra- alveolar foamy macrophages and lipoid droplets favoring lipoid pneumonia. Patient’s history was thoroughly reviewed and it was noted that the patient used a large amount of beard oil sprays and conditioners daily on his face. Patient reported at times inhalation of aerosolized oils when conditioning his facial hair. The patient’s lipoid pneumonia was likely due to aspiration of the facial oils. Patient was started on high dose steroids with improvement of his cough and shortness of breath. Discussion: In this case, we discuss an uncommon form of pneumonia. Currently, there is no standard of care for the treatment of lipoid pneumonia. Treatment is largely supportive with some evidence for high dose steroids to reduce inflammation. In all cases of exogenous lipoid pneumonia, stopping the offending agent is imperative to prevent further damage. This case report demonstrates the importance of considering uncommon types of pneumonia.
POSTER PRESENTATIONS – RESIDENTS
TB OR NOT TB, THAT IS THE QUESTION Trac Le, Sofia Beg; Department of Medicine, Leonard J. Chabert Medical Center, Houma, LA.
Introduction: Tuberculosis (TB) is one of the leading causes of adrenal insufficiency worldwide, but conversely adrenal insufficiency is less frequently found in active TB. Case: A 27 year old male with no prior medical history presented with two days of fatigue, muscle cramps, and excessive sweating. He was noted to have biapical airspace disease on initial CXR which was confirmed on CT Chest, though he did not have
any respiratory symptoms. Due to his risk of living in an endemic area, TB was strongly considered however the patient’s PPD skin testing and serial AFB smears returned negative. The patient was admitted to the hospital for treatment of acute renal failure and rhabdomyolysis. He symptomatically improved with intravenous fluids but remained hyponatremic, hyperkalemic, and with non-anion gap metabolic acidosis in the setting of persistent hypotension. These electrolyte abnormalities and
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