Abstract Introduction Chyloptysis is a rare medical condition characterized by thick, milky-white secretions that can form bronchial casts. Given its nonspecific respiratory symptoms and resemblance to mucous produced by infection, asthma and COPD, there is often a delay in diagnosis. Chylopytsis is diagnosed through stain-Oil Red O and is thought to occur through two main mechanisms of action. The first through lymphatic obstruction and the second through a bronchopleural fistula in the setting of a chylous pleural effusion. We present a case of a middle-aged man who presented with a history of progressive thick white secretions and multifocal pneumonia. Case Report: A 55 year-old male with T2DM and nicotine use presented with multiple months of progressive thick white secretions and was found to have hypoxic respiratory failure in setting of multifocal pneumonia. Patient was started on Unasyn and subsequently developed acute respiratory distress syndrome (ARDS) requiring intubation. Bronchoscopy was performed and found evidence of bronchial cast and confirmed secretions to be chylous material by stain-Oil Red O (ORO). Patient transferred to tertiary center for further workup. A repeat bronchoscopy was performed and was noted for negative cultures and cytology. Once extubated, the patient was able to confirm an extensive vaping history over the proceeding months, where he was compulsively vaping nicotine throughout the day, and denied any recent thoracic trauma. Lymphangiogram was completed but was unable to identify the source of chyloptysis, including lympangectasia and lymphangioleiomyomatosis. Pulmonology was consulted and suspected the source of chyloptysis to be secondary to vape-associated lung injury (VALI). Discussion While chyloptysis has primarily been noted in bronchial-pleural fistulas and thoracic lymphatic obstructions, this is the first reported case of chlyoptysis-associated with VALI which was diagnosed with the aid of stained-ORO a fat soluble, hydrophobic diazzo dye that stains neutral fat, fatty acids and triglycerides (Histochemistry 1992;97:493). We postulate that vaping, which is known to be cytotoxic, interrupts the structure of the lung which allowed for the passage of chyle into the alveolar compartment which resulted in both a multi-focal pneumonia as well as expectorated chyle. Before the diagnosis of VALI-induced chyloptysis can be made, it is crucial to rule out other causes such as structural defects, infections, and malignancies. This abstract is funded by: None
Herbert et al. (Fri,) studied this question.