A42-03 When Relief Turns Risky: A Case of Vicks Vaporub®-induced Lipoid Pneumonia

Abstract Introduction Vicks VapoRub® is a widely used over-the-counter product made of petroleum-based substances, typically applied topically for relief from upper respiratory symptoms. However, its chronic misuse can lead to rare but significant pulmonary complications. This case highlights an unusual presentation of exogenous lipoid pneumonia (ELP) induced by prolonged Vicks VapoRub® use. Case Presentation A 68-year-old woman with a psychiatric history was brought to the emergency department for altered mental status. On arrival, she was hypoxemic. Initial imaging showed bilateral hazy opacities suggestive of pulmonary edema, but cardiac markers and ECG were unremarkable. Altered mentation was found to be secondary to prescribed benzodiazepine use. After stabilization, a chest CT revealed numerous bilateral airspace opacities with fat attenuation and interlobular septal thickening—findings highly suggestive of ELP. Upon further investigation by the pulmonology team, the patient disclosed a chronic cough lasting one to two years, associated with scant, pink sputum. Importantly, she revealed prolonged use of Vicks VapoRub®, not only applied to her chest but also inside the oral cavity once or twice weekly over several years. She denied chemical or occupational exposures but reported a long history of tobacco use. Given the clinical context, a diagnosis of ELP was made, likely due to chronic inhalation of mineral oil (petrolatum) from Vicks VapoRub®. Infectious causes such as histoplasmosis and blastomycosis were ruled out, and although sputum samples for Acid Fast Bacilli were not obtained, clinical suspicion remained low. The mainstay of treatment—cessation of exposure—was strongly advised. Outpatient follow-up was arranged with pulmonary function testing and repeat CT imaging. Discussion ELP most often results from the aspiration of mineral oil, which may be ingested as a treatment for constipation or applied intranasally as a decongestant or home remedy for upper airway symptoms like nasal dryness. Clinical presentation can be acute (especially in children). Most patients, however, are either diagnosed incidentally or present with dyspnea on exertion and chronic cough. CT imaging is key to diagnosis, often showing ground-glass opacities with fat attenuation (< -30 Hounsfield units) and septal thickening. Bronchoalveolar lavage can be performed which sometimes show lipid-laden macrophages with large vacuoles that stain positive with Oil-Red-O stain however false-negative results are not uncommon. This case underscores the importance of thorough exposure history in patients with nonspecific respiratory symptoms and highlights the potential dangers of improper or prolonged use of seemingly harmless topical agents like Vicks VapoRub®. This abstract is funded by: None