C62-10 Severe Lipoid Pneumonia and ARDS Following Olive Oil Administration in a Toddler

Abstract Background Lipoid pneumonia is an uncommon but serious cause of respiratory failure in children, often resulting from aspiration of lipid-containing substances. Case Presentation A 21-month-old previously healthy male initially admitted to PICU for altered mental status in the setting of hypermagnesemia who developed pneumomediastinum following olive oil ingestion administered by a caregiver to treat diarrhea and complicated by acute respiratory distress syndrome (ARDS). At an outside hospital, he presented with depressed mental status (GCS 8) and severe hypermagnesemia (Mg 9.7 mg/dL) after repeated administration of magnesium oxide mixed with olive oil. He was transferred to a JHH PICU for escalating respiratory distress and diffuse pulmonary opacities. Course Upon admission he presented with respiratory distress and found to have pneumothoraxes and pneumomediastinum, managed conservatively on high flow nasal canula. Due to clinical worsening, a bronchoscopy was performed. This was negative for infectious causes and revealed lipid-laden macrophages, confirming aspiration and suspected etiology of exogenous lipoid pneumonia. His course was complicated and required intubation with mechanical ventilation on ARDS protocol for 9 days. He was treated with a 2-week course of corticosteroids, aggressive airway clearance, and broad-spectrum antibiotics with azithromycin for its anti-inflammatory effects. Left column initial chest CT. Right Column, Chest CT a week later. A video fluoroscopic swallow study demonstrated silent aspiration of thin liquids, leading to restriction to solids and soft textures under SLP guidance. Cardiac evaluation showed normal ventricular function and no pulmonary hypertension. Electrolyte abnormalities normalized with calcium gluconate and IV fluids. Outcome The patient was discharged stable on room air, transitioned to the pulmonology service for sedative weaning, and planned for outpatient pulmonary follow-up. Conclusion This case highlights the potential for life-threatening lipoid pneumonia and ARDS following home administration of oily substances in the pediatric population. It underscores the importance of community education about traditional remedies, cultural background since this is a common practice in several countries in Latin America and Asia and the need for multidisciplinary care in recovery, including airway clearance, steroid therapy, and aspiration risk management. This abstract is funded by: None