85 research outputs found
Lipoid pneumonia: An uncommon entity
Lipoid pneumonia is a rare form of pneumonia caused by inhalation or
aspiration of fat-containing substances like petroleum jelly, mineral
oils, certain laxatives, etc. It usually presents as an insidious
onset, chronic respiratory illness simulating interstitial lung
diseases. Rarely, it may present as an acute respiratory illness,
especially when the exposure to fatty substance(s) is massive.
Radiological findings are diverse and can mimic many other diseases
including carcinoma, acute or chronic pneumonia, ARDS, or a localized
granuloma. Pathologically it is a chronic foreign body reaction
characterized by lipid-laden macrophages. Diagnosis of this disease is
often missed as it is usually not considered in the differential
diagnoses of community-acquired pneumonia; it requires a high degree of
suspicion. In suspected cases, diagnosis may be confirmed by
demonstrating the presence of lipid-laden macrophages in sputum,
bronchoalveolar lavage fluid, or fine needle aspiration cytology/biopsy
from the lung lesion. Treatment of this illness is poorly defined and
constitutes supportive therapy, repeated bronchoalveolar lavage, and
corticosteroids
Azathioprine induced pancytopenia: A serious complication
Azathioprine is commonly used for treatment of lupus nephritis.
Myelosuppression is known to occur with azathioprine, but severe
pancytopenia is uncommon. A 23-year-old man with lupus nephritis was
initially treated with intravenous cyclophosphamide pulses and oral
prednisolone along with enalapril and frusemide. Following six months
of cyclophosphamide, he was initiated on oral azathioprine as
maintenance therapy. He subsequently returned with febrile neutropenia
and severe bone marrow suppression. Fever responded to broad spectrum
antibiotics and his counts gradually improved following
granulocyte-macrophage colony stimulating factor. When last seen in
October, he was symptom free and disease activity in control. We
suggest that physicians remain sensitive to possibility of azathioprine
induced severe bone marrow suppression. Frequent monitoring of blood
counts is probably the best way to avoid this complication specially,
where testing for thiopurine methyltransferase is not available
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