title: Exogenous lipoid pneumonia superinfected with acid-fast bacilli in infants: a report of nine cases.
abstract: Super-infection of an exogenous lipoid pneumonia by nontuberculous mycobacteria has been described in the literature. It produces a distinctive histologic picture with suppurative, noncaseating granulomas surrounding lipid vacuoles containing acid-fast bacilli. Mainly isolated cases have been found, but seldom in children. We describe a series of 9 children with similar histological findings. All our patients were under 1 year of age, malnourished, and with chronic respiratory symptoms. The diagnosis, based on the characteristic histology with acid-fast rods, was established at autopsy in 4 cases, on lobectomy specimens in 4 and by open lung biopsy in 1. Mycobacterium fortuitum-chelonei was cultured in 1 case. Gastro-esophageal reflux was documented in all 4 cases in which it was explored. Aspiration of lipid gastric contents or of oil given as medication can result in exogenous lipoid pneumonia, which in turn becomes super-infected with mycobacteria. Recognition of the distinctive histology permits the diagnosis of this complication.
authors.affiliation: Department of Pathology, National Institute of Pediatrics, Mexico City, DF, Mexico. cridaura@correo.unam.mx
authors.forename: Cecilia
authors.initials: C
authors.lastname: Ridaura-Sanz
authors.forename: Eduardo
authors.initials: E
authors.lastname: López-Corella
authors.forename: Margarita
authors.initials: M
authors.lastname: Salazar-Flores
mesh_terms: D017809:Fatal Outcome; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000473:pathology; D006801:Humans; D007223:Infant; D008168:Lung / Q000473:pathology; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications* / Q000473:pathology; D016926:Mycobacterium chelonae / Q000302:isolation & purification* / Q000502:physiology; D019907:Mycobacterium fortuitum / Q000302:isolation & purification* / Q000502:physiology; D011017:Pneumonia, Lipid / Q000382:microbiology* / Q000473:pathology; D015163:Superinfection