The Paradox of Metachronous Lipoid Pneumonia

A 70-year-old female patient diagnosed with stage IV EGFR-mutant non-small-cell lung cancer experienced three distinct instances of exogenous lipoid pneumonia while undergoing chemotherapy. Chest CT consistently revealed ground-glass opacities with a crazy-paving pattern, and bronchoscopy confirmed the presence of lipid-laden, CD163-positive foamy macrophages. It is noteworthy that each episode was associated with a distinct exogenous exposure: intranasal administration of petroleum jelly, prolonged utilisation of a kerosene heater, and subsequently, intranasal application of Junma Moisturising Oil. The localisation of all episodes to the right middle lobe was noted, and resolution was attained with the cessation of the offending agent. This is the first reported case of recurrent exogenous lipoid pneumonia in a single patient caused by multiple unrelated substances. This case underscores the diagnostic value of radiologic patterns, the significance of meticulous exposure history, and the necessity of contemplating alternative aetiologies in patients with new infiltrates during cancer therapy.