Severe Hydrocarbon Pneumonitis, a Fatal Complication of Petroleum Aspiration: A Case Report

Corresponding Author:

Neema Francis, EM resident, Tawam Hospital, Al Ain, UAE,
E-mail: neemafrancis97@gmail.com

Received: 28-September-2023, Manuscript No. ijocs-23-115205; Editor assigned: 29- September-2023, PreQC No. ijocs-23-115205(PQ); Reviewed: 9-October-2023, QC No. ijocs-23-115205(Q); Revised: 12- October-2023, Manuscript No. ijocs-23-115205(R); Published: 25-O1-2024, DOI: 10.37532/1753-0431.2024.18 (1).335

Abstract

This case report outlines a complex and unfortunate clinical scenario involving a patient who ingested a substantial amount of petroleum, leading to Acute Respiratory Distress Syndrome (ARDS), chemical pneumonitis, and subsequent complications. Despite rigorous interventions, including mechanical ventilation, antibiotic therapy, and procedural measures, the patient's condition progressively worsened, culminating in a fatal outcome. This report highlights the intricate challenges faced while managing such cases and underscores the significance of early recognition, aggressive treatment, and multidisciplinary care in enhancing patient outcomes.

Keywords

Acute Respiratory Distress Syndrome; antibiotic therapy; aggressive treatment; multidisciplinary care

Introduction

Severe hydrocarbon pneumonitis due to petroleum ingestion is a rare yet potentially fatal condition, with an incidence of less than 2% [1]. Children are particularly prone to accidentally ingesting hydrocarbon-laden agents in household items, representing the at-risk primary demographic. Occupational exposure to hydrocarbon fumes when dealing with petroleum products can also put workers at risk of developing hydrocarbon pneumonitis. In developing countries, fuel siphoning is another typical instance in which hydrocarbon pneumonitis can occur, such as in our case.

Hydrocarbon pneumonitis develops as a consequence of inadvertent inhalation or ingestion of hydrocarbon-containing substances [2, 3]. Once these hydrocarbons reach the lungs, they disrupt the function of surfactant, vital for maintaining alveolar stability and reducing surface tension. This disruption leads to decreased pulmonary compliance and bronchial edema, contributing to tissue damage in the lung parenchyma.

Furthermore, the inhaled hydrocarbons impair the mucociliary clearance mechanism, preventing efficient removal of particles from the respiratory tract. These lipid-rich hydrocarbons accumulate within the alveoli which triggers an inflammatory response, involving the activation of macrophages that attempt to break down the lipids. While some lipids may remain isolated within macrophages, they are eventually released back into the alveoli when the macrophages rupture. This process can further incite a giant cell response, potentially leading to fibrosis and long-term lung damage. The dangers of hydrocarbon pneumonitis lie in its potential to induce ARDS, sepsis, and other life-threatening complications such as respiratory failure. Such impairment can lead to oxygen deprivation, exacerbating respiratory distress and jeopardizing the patient's morbidity and mortality. Although the majority of documented cases, regardless of whether they presented acutely or developed insidiously, resulted in positive clinical outcomes with minimal morbidity or mortality, this is, unfortunately, not true in our case.

Case Presentation

This case report depicts the complex and challenging fate of a 28-year old male who suffered from severe hydrocarbon pneumonitis subsequent to accidental petroleum aspiration and ingestion while he was siphoning fuel from one vehicle to another. After the incident, the patient began coughing violently, which was when an ambulance was called. His symptoms continued to worsen on the way to the hospital leading to a significant drop in oxygen saturation levels to the 80s. He was placed on a non-rebreather mask, and his oxygen saturation levels improved to 95%-97%. The patient's initial presentation was marked by severe respiratory distress and agitation(Figure 1a). Physical examination revealed a bilateral decrease in air entry, notably more pronounced on the right side. The Glasgow Coma Scale (GCS) score began to deteriorate, prompting the urgent need for endotracheal intubation in the Emergency Department (ED), followed by admission to the Intensive Care Unit (ICU) for specialized management(Figure 1b).

Following stabilization, Computed Tomography (CT) scans of the patient's lungs unveiled significant findings, encompassing bilateral consolidations with air Broncho grams, groundglass opacities, septal thickening featuring a characteristic crazy paving appearance, and nodules displaying ground-glass attenuation. Remarkably, the upper and right middle lobes bore extensive involvement, accentuated by a central and perihilar predilection. These compelling imaging results collectively and conclusively confirmed the diagnosis of severe hydrocarbon pneumonitis. Through an interdisciplinary approach, the primary objective was to facilitate the patient's transfer to an alternate facility equipped with Extracorporeal Membrane Oxygenation (ECMO) capabilities, given its unavailability at our institution. Regrettably, the designated facility also lacked available ECMO machines at that time and a symptomatic management plan was devised and initiated within our facility with the understanding that the patient's care would continue while awaiting the availability of a suitable ECMO machine. Throughout hospitalization, daily chest X-rays and repeat CT scans played a pivotal role in tracking the progression of the patient's condition, which showed the development of multiple pneumothoraces and pleural effusions that required chest tube insertions(Figure 2a). Despite prone positioning, the patient's clinical trajectory continued to deteriorate to a point where transferring him to an ECMO facility was no longer feasible. Unfortunately, the cumulative effects of severe hydrocarbon pneumonitis, combined with recurring complications unresolvable to treatment, ultimately culminated in the patient's tragic demise arising from bilateral lung injury and multi-organ failure Figure 2b[4].

Discussion

Supportive care forms the foundation of hydrocarbon pneumonitis management. Statistics reveal that approximately 80% of cases resolve spontaneously with symptomatic treatment [3]. These findings underscore the importance of promptly addressing respiratory distress and optimizing oxygenation levels in these patients. Early recognition and intervention significantly impacts patient outcomes. Delayed diagnosis and treatment can lead to severe complications, such as pneumothorax and ARDS, occurring in approximately 10%-15% of cases [2, 3]. Prompt intervention and vigilant monitoring are pivotal in preventing these complications and improving prognosis. In select cases of severe hydrocarbon pneumonitis, advanced therapies such as ECMO may be considered. 4 Statistics indicate that ECMO is required in approximately 5%-10% of patients with severe respiratory distress unresponsive to conventional ventilatory support. ECMO provides a lifeline for these patients, offering a chance for recovery while supporting adequate gas exchange. The prognosis in hydrocarbon pneumonitis is generally favorable, with most patients recovering without long-term sequelae. 3 However, complications can significantly impact outcomes, with mortality rates ranging from 10% to 30% in severely complicated cases. Early recognition, prompt management, and complication prevention improve overall prognosis. Despite advances in understanding and managing hydrocarbon pneumonitis, there remains a pressing need for further research to refine treatment strategies and improve outcomes. Large-scale clinical trials investigating the efficacy of corticosteroids, optimal ventilation strategies, and the role of ECMO in specific patient populations are warranted. Mortality statistics for hydrocarbon pneumonitis are not readily available or widely reported in the literature. Mortality rates can vary significantly depending on the severity of the condition, the timeliness of intervention, and the presence of complications. Additionally, research focused on identifying risk factors for complications and strategies for their prevention is also vital.

Conclusion

In conclusion, managing severe hydrocarbon pneumonitis presents a multifaceted challenge, with statistics offering valuable insights into treatment strategies and outcomes. While supportive care and timely recognition are crucial, the significance of advanced therapies like ECMO in select cases, and the impact of complications on prognosis, cannot be overstated. Further research remains imperative to advance our understanding and enhance the management of this complex condition.

References

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