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Unresolving Pneumonia  

Bang, Do Seok (Department of Internal Medicine, Sun Hospital)
Jung, In Sung (Department of Internal Medicine, Sun Hospital)
Kang, Ki Man (Department of Internal Medicine, Sun Hospital)
Park, Bum Chul (Department of Internal Medicine, Sun Hospital)
Yoon, Young Gul (Department of Internal Medicine, Sun Hospital)
Kim, Jae Su (Department of Internal Medicine, Sun Hospital)
Park, Yol (Department of Internal Medicine, Sun Hospital)
Lee, Sung Hoon (Department of Internal Medicine, Sun Hospital)
Hong, Young Chul (Department of Internal Medicine, Sun Hospital)
Ko, Kyoung Tae (Department of Internal Medicine, Sun Hospital)
Park, Sang Min (Department of Internal Medicine, Sun Hospital)
Na, Dong Jib (Department of Internal Medicine, Sun Hospital)
Publication Information
Tuberculosis and Respiratory Diseases / v.57, no.6, 2004 , pp. 604-608 More about this Journal
Abstract
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 $39^{\circ}C$, 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 $39^{\circ}C$ 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.
Keywords
Pneumonitis; Kerosene;
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