Lipoid Pneumonia Following Chronic Aspiration of Cannabis Oil Used for the Treatment of Seizures.

A 4-year-old girl with ring chromosome 14, epilepsy, global developmental delay, and failure to thrive presented for a preoperative assessment for gastrostomy tube (G-tube) insertion and was incidentally found to be hypoxemic, with saturations of 81% in room air. There was no history of fever or upper respiratory tract infection symptoms; however, her parents described a progressive history of choking and emesis with feeds over 3 months. Chest radiograph demonstrated patchy alveolar opacities in the right lower and middle lobes. She was admitted to the hospital and treated with supplemental oxygen and IV ampicillin for a suspected aspiration pneumonia. On day 3 of her admission, because of persistent hypoxemia despite high-flow nasal cannula support at 2 L/kg/min with an Fio2 of 0.6 to 0.7, and frequent need for suctioning of thick yellow secretions, she was transferred to the PICU for escalation to noninvasive ventilation. Because of poor response after 7 days, and respiratory secretions showing moderate growth of Klebsiella oxytoca and light growth of Stenotrophomonas maltophilia, sulfamethoxazole-trimethoprim was added. Azithromycin was also started on day 8 to cover atypical pathogens, then discontinued when Mycoplasma pneumoniae polymerase chain reaction was negative.