Lipoid Pneumonia Following Chronic Aspiration of Cannabis Oil Used for the Treatment of Seizures.

Abstract

A 4-year-old girl with ring chromosome 14, epilepsy, global developmental delay, and failure to thrive presented for a preoperative assessment for gastrostomy tube (G-tube) insertion and was incidentally found to be hypoxemic, with saturations of 81% in room air. There was no history of fever or upper respiratory tract infection symptoms; however, her parents described a progressive history of choking and emesis with feeds over 3 months. Chest radiograph demonstrated patchy alveolar opacities in the right lower and middle lobes. She was admitted to the hospital and treated with supplemental oxygen and IV ampicillin for a suspected aspiration pneumonia. On day 3 of her admission, because of persistent hypoxemia despite high-flow nasal cannula support at 2 L/kg/min with an Fio₂ of 0.6 to 0.7, and frequent need for suctioning of thick yellow secretions, she was transferred to the PICU for escalation to noninvasive ventilation. Because of poor response after 7 days, and respiratory secretions showing moderate growth of Klebsiella oxytoca and light growth of Stenotrophomonas maltophilia, sulfamethoxazole-trimethoprim was added. Azithromycin was also started on day 8 to cover atypical pathogens, then discontinued when Mycoplasma pneumoniae polymerase chain reaction was negative.