Toronto — Canadian doctors have linked natural, oil-based decongestants to a case of persistent pneumonia in a 30-year-old patient who regularly gargled with flaxseed oil and used a sesame oil nasal spray.
According to a case report published in peer-reviewed canadian medical association journal On Tuesday, the Polish man, who had been living as a student in Toronto for most of the past two years, visited the emergency department for chest pain.
The report said he was diagnosed with pneumonia in Poland about two weeks ago and was treated with a 14-day course of an antibiotic, clarithromycin.
The man was a lifelong non-smoker, rarely drank alcohol and did not use any recreational drugs or electronic cigarettes. According to the report, his medical history included irritable bowel syndrome, recurrent sinusitis and persistent symptoms of dry mouth that started after tonsillectomy.
Despite several courses of antibiotics, doctors said the symptoms of chest pain and shortness of breath recurred and the pneumonia failed to resolve.
While several CT scans ruled out pulmonary embolism, the report noted that the scans showed “persistent bilateral consolidation, nodules and ground-glass opacity” in the right middle lobe, right lower lobe and left lower lobe.
Upon further investigation, doctors say the biopsy revealed a foreign substance surrounded by inflammation in the patient’s lungs. Another test also showed yellow mucoid secretions originating from the right lung.
According to the case report, the patient’s cell samples were normal and the culture samples showed no evidence of harmful bacteria, fungi or viruses, including SARS-CoV-2, the virus that causes COVID-19. Abnormal deposits in the lungs were also excluded.
“This prompted us to take a detailed history of environmental exposure to evaporating liquids, silica, asbestos, talc and many other organic and inorganic materials,” the report’s authors wrote.
Physicians report that the patient denied these risks, but disclosed that he had been “swishing and spitting” flax seed oil for the past 12 years to help his symptoms of dry mouth. He also said that he recently started coughing after this procedure.
In addition, the patient reported that he had been using a nasal decongestant made of natural sesame oil to help his sinusitis for the past two years.
Doctors report that using these products causes the patient to inhale tiny droplets of the oil, which leads to lung inflammation and pneumonia.
“Given this exposure history and consistency with pathology results, we diagnosed exogenous lipoid pneumonia and advised the patient to stop antibiotics and oil products,” the authors wrote.
According to case reports, exogenous lipoid pneumonia is a rare cause of non-resolving pneumonia that may present with a superimposed bacterial infection.
Doctors reevaluated the patient three months after she stopped using flax seed oil and sesame oil nasal spray. The patient reported feeling better and less tired, but still experienced shortness of breath if he exhausted himself. Doctors said that pulmonary function tests done at this time also showed improvement in his lung volume.
The authors note that this case emphasizes the value of taking into account a complete patient history in making an accurate diagnosis.
“Our case highlights the importance of taking a detailed history that includes exposure to fatty or oily substances, especially when inhaled or applied to the nasopharynx or oropharynx, as part of a work-up for non-resolving pneumonia. ,” they wrote.
The authors have reported this adverse event from using sesame oil nasal spray to Health Canada’s Directorate of Natural Products.