Pediatric exogenous lipoid pneumonia caused by paraffin oil aspiration: a case report

Objective This case report describes a rare pediatric case of exogenous lipoid pneumonia caused by repeated paraffin oil aspiration and highlights the importance of detailed exposure history, early recognition, and timely intervention. Case presentation We report the clinical course, diagnostic assessment, treatment, and follow-up of a 4-month-old former preterm infant admitted to the pediatric intensive care unit with severe pneumonia. Results Repeated targeted history-taking revealed multiple oral administrations of liquid paraffin with choking episodes. Chest CT showed bilateral consolidation, ground-glass opacities, interlobular septal thickening, a crazy-paving pattern, and a focal area of fat attenuation. BALF cytology showed vacuolated histiocytes, although lipid-specific staining was unavailable. Klebsiella aerogenes was detected by throat-swab and BALF targeted next-generation sequencing and was isolated from sputum culture, supporting concomitant lower respiratory tract infection. Following discontinuation of paraffin exposure and multimodal management, the patient showed clinical and radiological improvement. Conclusion Exogenous lipoid pneumonia should be considered in infants with treatment-refractory pneumonia and intralesional fat attenuation on CT. Diagnosis requires integration of exposure history, imaging, BALF findings, microbiological evidence, and clinical course. Because several interventions were administered concurrently and long-term follow-up was incomplete, the efficacy of individual treatments and late pulmonary outcomes could not be determined.