A 59 year-old lady with a history of diabetes, hypertension, and coronary artery disease presented to the emergency department complaining of progressive shortness of breath over a 6 month period. On initial
examination she was found to be hypoxemic with a PaO2 of 50 mmHg. A chest radiograph left lower lobe consolidation. The patient was given broad-spectrum antibiotics and admitted to the intensive care unit (ICU). In the ICU she remained on antibiotics and bronchodilator therapy was started. Despite these interventions, she showed no evidence of improvement over next 48 hours.
Additional questioning revealed that the patient had a history of chronic constipation for which she had been using mineral oil as a laxative over the last decade. A computed tomography (CT) scan of chest revealed a large area of consolidation extending from the left hilum into the left lower lobe with satellite nodules in the left lower lobe.