Hydrocarbon compounds are easily accessible products. Exposure to hydrocarbons is usually by accidental ingestion especially in children younger than 5 years. Pneumonitis is the most common complication of hydrocarbon ingestion. However; formation of lung abscess and pneumatoceles is believed to be a very rare event. Herein; we report a four year old child with hydrocarbon pneumonitis who had developed lung abscess and pneumotocele.Hidrokarbon bileşikleri kolaylıkla ulaşılabilen ürünlerdir. Hidrokarbonlara maruziyet genellikle kaza sonucu içme ile özellikle 5 yaş altı çocuklarda olur. Pnömonit hidrokarbon alımının en sık komplikasyonudur. Bununla birlikte akciğer apsesi ve pnömotosel oluşumunun oldukça nadir bir olay olduğuna inanılır. Burada akciğer apsesi ve pnömotosel gelişen hidrokarbon pnömonitli dört yaşında bir çocuk sunuldu

Babayiğit, Arzu

KARAMAN, ÖZKAN

TUNCEL, TUBA

UZUNER, NEVİN

ÇAKMAKÇI, HANDAN

Ölmez, Duygu

English

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 Olgu Sunumu  © 2011 DEÜ TIP FAKÜLTESİ DERGİSİ                                                                                       CİLT 25, SAYI 2, (MAYIS) 2011, S: 103 - 106 103   Lung Abscess and Pneumatocele After Accidentally Kerosene Ingestion in a Child KAZA İLE GAZ YAĞI İÇİMİ SONRASI BİR ÇOCUKTA AKCİĞER APSESİ VE PNÖMOTOSEL     Tuba TUNCEL1, Duygu ÖLMEZ1, Arzu BABAYİĞİT1, Özkan KARAMAN1, Handan ÇAKMAKÇI2, Nevin UZUNER1  1 Dokuz Eylül Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Çocuk Allerji Bilim Dalı  2 Dokuz Eylül Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı         Tuba TUNCEL Dokuz Eylül Üniversitesi  Tıp Fakültesi  Çocuk Alerji Bilim Dalı Tel: (232) 4123662 Fax: (232) 4123601 GSM: (505) 2371475 SUMMARY Hydrocarbon compounds are easily accessible products. Exposure to hydrocarbons is usually by accidental ingestion especially in children younger than 5 years. Pneumonitis is the most common complication of hydrocarbon ingestion. However; formation of lung abscess and pneumatoceles is believed to be a very rare event. Herein; we report a four year old child with hydrocarbon pneumonitis who had developed lung abscess and pneumotocele. Key words: Hydrocarbon pneumonitis, lung abscess, child, pneumatocele  ÖZET Hidrokarbon bileşikleri kolaylıkla ulaşılabilen ürünlerdir. Hidrokarbonlara maruziyet genellikle kaza sonucu içme ile özellikle 5 yaş altı çocuklarda olur. Pnömonit hidro-karbon alımının en sık komplikasyonudur. Bununla birlikte akciğer apsesi ve pnömotosel oluşumunun oldukça nadir bir olay olduğuna inanılır. Burada akciğer apsesi ve pnömotosel gelişen hidrokarbon pnömonitli dört yaşında bir çocuk sunuldu. Anahtar sözcükler: Hidrokarbon pnömoniti, akciğer apsesi, çocuk, pnömotosel Kerosene  is  a  low  viscosity  liquid  hydrocarbon  com‐pound.  Exposure  to  hydrocarbons  is  especially  easier  in lower socioeconomic status. The highest rates of morbidity and mortality result from accidental ingestion by children younger  than  5  years.  Pulmonary  toxicity  is  the  major cause of morbidity and mortality. It is followed by Central Nervous System (CNS) and cardiovascular complications (1). CASE REPORT  A  four year‐old girl was  admitted  to  a  local hospital because  of unknown  amount  of  kerosene  ingestion  acci‐dentally. She was forced to vomit by her family. When she arrived  the hospital, she was  lethargic and dyspneic. Her chest X‐ray was normal on admission but after six hours the following X‐ray revealed pneumonic infiltration in the left  lung.  Oxygen,  intravenous  fluid  therapy  and  par‐enterally  ceftriaxone  were  started.  Although  her  neuro‐logical  status  improved  immediately,  respiratory  symp‐toms  and  fever  didn’t  recover  till  the  fifth  day  of  the treatment and she referred to our hospital. On admission, she was tachypneic, dyspneic with respiratory rate 60/min and  had  intercostal  retractions,  body  temperature  was Lung abscess and pneumatocele after accidentally kerosene ingestion in a child  10438ºC (axillary), oxygen saturation was 97%. Breath sounds were diminished at the basis of left lung by auscultation of the  chest.  Laboratory  evaluation  showed  leucocytosis (WBC; 14000/mm³), anemia  (Hb; 10,5 gr/dl), high C‐reac‐tive protein  level  (CRP:  245mg/L)  and  elevated  liver  en‐zymes (SGOT:170 IU/L, SGPT:230 IU/L). Other laboratory findings were normal. Chest  X‐ray  revealed  pneumonic  infiltration  in  the lower  lobe  of  the  left  lung. Antibiotics were  changed  to teicoplanin  and meropenem  and  1 mg/kg/day  predniso‐lone was  given  additionally.  Three  days  after  this  treat‐ment,  fever was  ceased  and  her  clinical  status was  im‐proved. At the end of the first week of the treatment, chest X‐ray (Fig 1) and Computerized Tomography (CT) of tho‐rax (Fig 2) showed decrease in infiltration but cavity with air‐fluid was evident  in  the  lower  lobe of  the  left  lung.  It was presumed as  lung abscess. Antibiotics and predniso‐lone  were  continued. White  blood  cell  count,  CRP  and liver  enzymes decreased  to normal  limits  after  ten days. Prednisolone  was  discontinued  after  two  weeks.  Her physical examination was completely normal and she had no complaints at that time. On the third week of the anti‐biotic treatment, abscess formation was disappeared but a thin walled pneumotocele was seen in chest X‐ray. Antibi‐otic  therapy was  continued  parenterally  for  four weeks. Chest X‐ray,  taken  about  one month  after  the  discharge (two months after accidentally ingestion), was completely normal.  DISCUSSION Liquid  hydrocarbons  derived  from  petroleum  are widely used  in household and  industry. These are easily accessible products. Most of  the dangerous hydrocarbons are  derived  from  petroleum  distillates  such  as  gasoline, furniture  polish,  household  cleaners,  kerosene,  propel‐lants,  solvents  and  other  fuels.  Exposure  may  occur  in different  ways  but  the  most  common  exposure  type  is accidental in children and it is related to the highest rates of  morbidity  and  mortality  (1).  Improper  storage  and mislabeled  containers of hydrocarbons  are  common  con‐tributing  factors  (2).  In our case kerosene was stored  in a bottle of water in the kitchen.     Figure 1.   Chest X-Ray of the patient. Air-fluid level in the left lung considers lung abscess (Lung abscess is marked with arrows)  Lung abscess and pneumatocele after accidentally kerosene ingestion in a child       105    Figure 2.    Computerized tomography of thorax (Abscess formation is marked with arrows)  As hepatic  injury was recognized by cause of chronic exposure  and  certain  hydrocarbon  ingestion,  it was  not reviewed  after  acute  kerosene  ingestion  (2).  In  our  case liver  enzymes were  found  elevated  and  it  could  not  be explained with another disease and was  recovered with‐out any specific therapy. Aspiration pneumonitis  is  the most  common  compli‐cation  of  hydrocarbon  ingestion  (40%)  (5). The  toxic po‐tential of hydrocarbons is directly related to their physical properties. Kerosene‐like highly volatile compounds with low  viscosity  are more  likely  to  be  inhaled  or  aspirated into  the  respiratory  system  (7).  Clinical  findings  are coughing,  choking,  fever,  cyanosis,  tachypnea,  grunting, wheezing,  and  rales.  Initially,  the  chest  X‐ray  may  be normal, but positive  findings may develop after  the  first few  hours  of  ingestion.  Common  findings  include  fine perihilar  opacities,  bibasilar  infiltrates,  and  atelectasis. Prophylactic  use  of  antibiotics  is  not  recommended  for prevention  of  hydrocarbon  pneumonitis  (1).  However once  signs  of  secondary  infection  developed,  antibiotic therapy  should  be  started. Choice  of  antibiotic  combina‐tion  should  cover  common  gram  positives,  gram  nega‐tives,  and  anaerobes  (8). Although  effects of  steroids  are not  explained  and  thought  to  be  harmful,  some  authors and we believed that steroids accelerate clinic recovery (9‐10).  In  the presented  case,  symptoms  improved  immedi‐ately after the beginning of the steroid therapy. However pneumatocele formation is a rare complication that occurs in  approximately  4%  of  the  patients  with  pneumonitis, only  few  cases  with  lung  abscess  were  reviewed  (11). Pneumatoceles  generally  appear  lately  (3‐15  days  after accident)  after  the  resolving  of  the  consolidation.  These Lung abscess and pneumatocele after accidentally kerosene ingestion in a child  106are  often  large,  septate  and  irregular  lesions  and  some‐times contain air‐fluid levels. The majority of these lesions resolve almost completely with no residual pleural or par‐enchymal scarring throughout for weeks and months (12‐14). In our case lung abscess appeared after the first week of  the  treatment and  resolved with pneumatocele  forma‐tion in the third week of the treatment.  Although  incidence  of  hydrocarbon  pneumonitis  de‐creased, it still remains a problem in developing countries as our country. We reported this case because lung abscess and pneumatocele  formation after hydrocarbon  ingestion is rare and the patient was treated with corticosteroid and antibiotics without any sequel. REFERENCES   1. Eade NR, Taussing LM, Marks MI. Hydrocarbon pneu-monitis. Pediatrics 1974; 54: 351- 357.    2. Klein BL, Simon JE. Hydrocarbon poisonings. Pediatr Clin North Am 1986; 33: 411- 419.   3. Lucas GN. Kerosene oil poisoning in children: a hospital-based prospective study in Sri Lanka. Indian J Pediatr 1994; 61: 683- 687.  4. Machado B, Cross K, Snodgrass WR. Accidental hydrocarbon ingestion cases telephoned to a regional poi-son center. Ann Emerg Med 1988;17: 804- 807. 5. Lifshitz M, Sofer S, Gorodischer R. Hydrocarbon poison-ing in children: a 5-year retrospective study. Wilderness Environ Med 2003; 14: 78- 82. 6.  Shotar AM. Kerosene poisoning in childhood: a 6-year prospective study at the Princess Rahmat Teaching Hospital. Neuro Endocrinol Lett 2005;26: 835- 838. 7. Beamon RF, Siegel CJ, Landers G, Green V. Hydrocar-bon ingestion in children: a six-year retrospective study. JACEP 1976; 5: 771- 775.  8. Singh H, Chugh JC, Shembesh AH, et al. Management of accidental kerosene ingestion. Ann Trop Paediatr 1992; 12: 105- 109.  9. Jamison K, Wallace E. Kerosene pneumonitis treated with adrenal steroids. California Med 1964;100: 43- 44.  10. Karacan Ö, Yılmaz İ, Eyüboğlu FÖ. Fire eater’s pneumonia after aspiration of liquid paraffin. Turk J Pe-diatr 2006; 48: 85- 88.  11. Aziz AA, Abdullah FA, Mahmud A. Lung abscess rather than pneumatocele following kerosene ingestion. British Journal of Hosp Med 2007; 68: 616- 617.  12. Bergeson PS, Hales SW, Lustgarten MD, Lipow HW. Pneumatoceles following hydrocarbon ingestion. Report of three cases and review of the literature. Am J Dis Child 1975; 129: 49- 54. 13. Harris VJ, Brown R. Pneumatoceles as a complication of chemical pneumonia after hydrocarbon ingestion.  Am J Roentgenol Radium Ther Nucl Med 1975;125:531-537. 14. Thalhammer GH, Eber E, Zach MS. Pneumonitis and pneumatoceles following accidental hydrocarbon aspira-tion in children. Wien Klin Wochenschr 2005;117:150- 153.       

KAZA İLE GAZ YAĞI İÇİMİ SONRASI BİR ÇOCUKTA AKCİĞER APSESİ VE PNÖMOTOSEL

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KAZA İLE GAZ YAĞI İÇİMİ SONRASI BİR ÇOCUKTA AKCİĞER APSESİ VE PNÖMOTOSEL

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