FIRE-EATER‘S PNEUMONIA– CASE REPORT

Background: Fire-eater’s pneumonia is a rare type of chemical pneumonitis developed after aspiration of hydrocarbon-based fuel during a fire-eating performance. Cough, dyspnea, and chest pain is reported to occur within the first twelve hours. The progression and severity of complications varies, with temporary restrictive lung disorders being reported. Methods: We describe the case of a 26-year-old healthy caucasian male, with a part-time job as a fire-breathing performer. He belongs to a nuclear family, highly functional, in Phase VI of Duvall’s cycle. The patient accidentally aspirated paraffin oil while practicing. Symptoms of dyspnea, severe chest pain, fever and cough developed two hours after the incident. At the ER, two days later, he was with dyspnea, febrile (38,1 ºC), desaturated (90% on room air) and his auscultation showed wheezing and crackles over the right lung. Results: The thoracic-CT showed a consolidation area completely covering the lateral segment of the right middle lobe, with small nodules in the middle and lower lobe. The bronchoalveolar lavage revealed lipid-laden macrophages. Amoxicillin/Clavulanic Acid, Azithromycin and steroids were introduced. Progressive laboratory, clinical and radiologic improvements were observed, being discharged on the seventh day. At follow-up, one-month later, he was completely recovered. Conclusions: Treatment of fire-eater's pneumonia remains controversial. Despite fever and serum markers of infection, it’s generally a pseudo-infectious lung disease with an intense inflammatory cytokine release. There’s no good evidence that systemic corticosteroids and antibiotics are effective. Although initial severe clinical and radiological presentation, there’s usually a favorable evolution with full recovery in weeks to months.