Pneumonia when antibiotics are not the answer

Lipoid pneumonia is a rare noninfectious pneumonia, which can usually be misdiagnosed because of its broad presentation, which can range from asymptomatic to respiratory findings such as cough, dyspnea, and hemoptysis. Lipoid pneumonia can be confused with other conditions including bacterial pneumonia, lung malignancy, and tuberculosis. We present the case of an 88-year-old bedridden man, with hypertension, multiple myeloma, coronary artery disease, ischemic stroke, seizures, dysphagia, and constipation under treatment with mineral oil. He was brought to the emergency department after 3 days of cough, dysphagia, and dyspnea, following a recent hospitalization, due to a health care-associated pneumonia. A chest computed tomography scan obtained showed bilateral multifocal opacities with consolidates described as Hounsfield units of -62, consistent with fat. A diagnosis of lipoid pneumonia was done, and mineral oil was discontinued. Given the patient's history of dysphagia, it was suspected that the mineral oil was aspirated and triggered an inflammatory response.