Diesel Aspiration Pneumonitis: A Rare but Serious Occupational Hazard

TL;DR

A 33-year-old man developed severe lung injury after accidentally inhaling diesel fuel, leading to acute respiratory distress syndrome.

Contribution

Highlights diesel aspiration as a rare but serious occupational hazard causing chemical pneumonitis and ARDS.

Findings

Diesel aspiration can lead to acute respiratory distress syndrome (ARDS) and severe lung injury.

Clinical recovery was observed with treatment using steroids, antibiotics, and furosemide.

Chest CT showed bilateral consolidations and ground-glass opacities consistent with aspiration pneumonitis.

Abstract

Chemical pneumonitis is frequently encountered in patients following the siphoning of diesel fuel, which can lead to severe complications, including acute respiratory distress syndrome (ARDS).

This is a 33-year-old male patient who presented with a history of dyspnea, a non-productive cough, and heartburn. His symptoms commenced five days earlier following an inadvertent aspiration of diesel while refueling vehicles. This patient was admitted to our intensive care unit as a case of ARDS related to chemical pneumonitis following siphoning of diesel fuel. This patient was treated with intravenous steroids, along with empirical antibiotics, and intravenous furosemide was utilized for the management of non-cardiogenic pulmonary edema, as seen a few days post-admission and noted on chest radiography.

As the patient’s clinical condition improved, he was discharged after achieving a stable oxygen saturation of 97% on room air, accompanied by significant clinical recovery. Aspiration pneumonitis occurs following the inhalation of chemical irritants, including hydrocarbons, which can cause direct injury to the alveoli without significant systemic absorption, primarily through the disruption of surfactant function, leading to an inflammatory response and bronchial edema that can progress to ARDS.

This patient was then transferred to the regular ward after marked clinical improvement, where a CT scan of the chest was done, which shows bilateral segmental and sub-segmental consolidations with air bronchograms, along with peripheral patchy ground-glass opacities and atelectatic bands observed in the right middle lobe, lingula, and both lower lobes. Empirical antimicrobial therapy was initiated with intravenous piperacillin/tazobactam to provide coverage against potential anaerobic pathogens that may contribute to aspiration pneumonia. Systemic corticosteroids were also used as it has potential benefits in cases of ARDS.

Siphoning of diesel fuel can cause serious complications, including aspiration pneumonitis, which can end up with ARDS. Physicians should understand the pathophysiology by which diesel fuel can result in severe lung injury, aiming for early diagnosis and effective appropriate management.

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