Patients commonly use petroleum-based over the counter remedies to alleviate symptoms of rhinitis. But such medicines carry risks of often under-appreciated side effects. In a recent report, researchers described a case in which a patient developed exogenous lipoid pneumonia (ELP) as a side-effect of a long-term petroleum-based remedy.
The case study reveals an 85-year-old patient with a history of recurrent allergic rhinitis events since childhood who applied an over-the-counter mentholated mineral ointment decongestant every day to her chest, palms and feet, and aspirated through the nose for approximately 50 years. At the time of the visit the patient had no signs or symptoms of respiratory disease. A chest radiograph revealed an irregular mass-like-lesion in the right lower lobe.
A thoracic computed tomographic (TCT) scan reveled the presence of intrapulmonary lipid (fat) leading doctors to recommend that the patient stop using Vicks VapoRub. Intranasal corticosteroids were then prescribed for the management of the rhinitis. Twenty-six months after the patient stopped using the petroleum-based remedy, the size of the mass had decreased and the pathologic pattern of the opacities had diminished as well.
The research paper, “Exogenous lipid pneumonia related to long-term use of Vicks VapoRub® by an adult patient: a case report,” was published in BMC Ear, Nose and Throat Disorders.
ELP is a rare condition that results from the aspiration or inhalation of material of animal, vegetable or mineral origin. The principal culprit in ELP is the inhalation of hydrocarbons found in petroleum that accumulate in the alveoli and ultimately lead to the onset of an inflammatory reaction. Most ELP cases stem “from the use of oil-based laxatives for the treatment of constipation, or from nasal instillation of oily products, including petroleum ointment products such as Vaseline or Vicks VapoRub® for relief of chronic rhinopharyngeal diseases,” according to the study.
ELP is difficult to diagnose, as its clinical and radiological presentations are nonspecific and mimic many other diseases. High-resolution computed tomography (CT) is the best imaging technique to accurately diagnose ELP. The presence of fat in mass-like lesions is a diagnostic feature of ELP.
“Physicians need to be aware of this chronic adverse effect and discourage the use of mineral oil and ointment. The ability to recognize radiological manifestations of ELP can help establish an early diagnosis and start timely intervention,” the researchers concluded.