| Unresolving Pneumonia. |
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Do Seok Bang, In Sung Jung, Ki Man Kang, Bum Chul Park, Young Gul Yoon, Jae Su Kim, Yol Park, Sung Hoon Lee, Young Chul Hong, Kyoung Tae Ko, Sang Min Park, Dong Jib Na |
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Department of Internal Medicine, Sun Hospital, DaeJeon, Korea. djna@sunhospital.com |
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| Abstract |
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A 47-year-old-man was admitted to the emergency department with dyspnea, right pleuritic pain, and high fevers for 3 days. He had a nonproductive cough that exacerbated the chest pain. A clinical examination revealed distressed and slightly tachypneic patient, with blood pressure of 110/90 mmHg, temperature of 39degrees C, pulse of 90 beats/min, respiratory rate of 24 breaths/min. A chest examination showed significantly diminished breath sounds in the right lung with dullness to percussion. Laboratory investigation demonstrated leukocytosis and a raised C-reactive protein. The results of arterial blood gas analysis revealed moderate hypoxemia. A radiograph and a CT scan of the chest showed extensive consolidation with multifocal low densities, and pleural effusion in the right lung. A diagnostic thoracentesis revealed straw-colored fluid, which was found to be a neutrophil-predominant exudate. At 7 days after admission, the clinical symptoms had not improved and the temperature was still 39degrees C despite the aggressive therapy of community- acquired pneumonia. After comprehensive history taking, we realized then that he accidentally aspirated kerosene while siphoning from fuel tank to put into the boiler 3 days ago. Bronchoscopy with bronchial washings could be successful in establishing the diagnosis of hydrocarbon pneumonitis by demonstration of a high lipid-laden macrophage index. Thereafter, the symptoms and radiographic opacities gradually improved, and he was discharged several days later. |
| Key Words:
Pneumonitis, Kerosene |
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