Lipoid pneumonia historical perspective

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ramyar Ghandriz MD[2]

Overview

In 1925, G. F. LAUGHLEN, M.D. was the first physician to describe lipoid pneumonia. He first interacted with the disease by routine autopsy at the Toronto, Ontario hospital for sick children. He described grayish red nodules at the autopsy with three types of exudates, found out mononuclear cells which were unexpected in the exudates. In 1949 McDonald et al described endogenous lipoid pneumonia for the first time. He observed so-called "obstructive pneumonia" in patients with lung neoplasms.

Historical Perspective

Discovery

• In 1925,G. F. LAUGHLEN, M.D. was the first physician to describe exogenous lipoid pneumonia.
• He first interacted to the disease by routine autopsy at the Toronto, Ontario hospital for sick children.
• He described grayish red nodules at the autopsy with three types of exudates, found out mononuclear cells which were unexpected in the exudates.
• All of his 4 observed cases underwent laxative and nasal drop therapy regimen.
• In 1949 McDonald et al described endogenous lipoid pneumonia for the first time.
• He observed so called "obstructive pneumonia" in patients with lung neoplasms.

Important landmark

Following are important landmark events that shows how aspiration pneumonia became an important entity of critical care:

Year	Events
460 BC–380 BC	Hippocrates described pneumonia.
1138–1204 AD	Maimonides wrote about pneumonia as "The basic symptoms which occur in pneumonia and which are never lacking are as follows: acute fever, sticking pleuritic pain in the side, short rapid breaths, serrated pulse, and cough."
1875	Edwin Klebs identified bacteria in the airways of individuals who died from pneumonia.
1848	Carl Friedländer identified the two common bacteria such as Streptococcus pneumoniae and Klebsiella pneumoniae that cause pneumonia.
1893	Veillon was first to write about the role of anaerobic bacteria in aspiration pneumonia.
1896	Roentgen described x-rays.
1918	Sir William Osler, known as "the father of modern medicine," appreciated the morbidity and mortality of pneumonia, describing it as the "captain of the men of death."
1927	Smith was first to clearly show anaerobic bacterial growth in animal models suffered from aspiration pneumonia.
1929	Drinker and Shaw announced the invention of the iron lung during the polio epidemic.
1985	Specimens collected from patients with aspiration pneumonia were vastly cultured and it was called anaerobic bandwagon.

Lipoid pneumonia outbreak

• During July and August 2019, five patients were identified at two hospitals in North Carolina with acute lung injury potentially associated with e-cigarette use.
• Patients were adults aged 18–35 years and all experienced several days of worsening dyspnea, nausea, vomiting, abdominal discomfort, and fever.
• All patients demonstrated tachypnea with increased work of breathing on examination, hypoxemia (pulse oximetry <90% on room air), and bilateral lung infiltrates on chest x-ray.
• All five patients shared history of recent use of marijuana oils or concentrates in e-cigarettes.
• Thirty-three deaths confirmed due to vaping in 24 states of US, but lipoid pneumonia role in those mortalities was not proven.
• The higher risk of lipoid pneumonia in THC vaping was then hypothesized to be due to usage of vitamin E in THC juice of e-cigarettes.
• Vitamin E is a substance added to cannabis products to increase their central effect.
• It's streaky and high solubility potential is said to be the cause of lipoid pneumonia.

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