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A cluster of lung injury associated with home humidifier use: clinical, radiological and pathological description of a new syndrome
  1. Sang-Bum Hong1,
  2. Hwa Jung Kim2,
  3. Jin Won Huh1,
  4. Kyung-Hyun Do3,
  5. Se Jin Jang4,
  6. Joon Seon Song4,
  7. Seong-Jin Choi5,
  8. Yongju Heo5,
  9. Yong-Bum Kim6,
  10. Chae-Man Lim1,
  11. Eun Jin Chae3,
  12. Hanyi Lee7,
  13. Miran Jung8,
  14. Kyuhong Lee5,
  15. Moo-Song Lee2,
  16. Younsuck Koh1,
  17. Korean Unknown Severe Respiratory Failure Collaborative, the Korean Study Group of Respiratory Failure
  1. 1Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
  2. 2Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
  3. 3Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
  4. 4Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
  5. 5Inhalation Toxicology Center, Korea Institute of Toxicology, Jeongeup, South Korea
  6. 6Toxicologic Pathology Center, Korea Institute of Toxicology, Daejeon, South Korea
  7. 7Department of Nursing, Hanyang University, Seoul, South Korea
  8. 8Department of Nursing, Asan Medical Center, Seoul, South Korea
  1. Correspondence to Professor Younsuck Koh, Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-dong, Songpa-Ku, Seoul, South Korea; yskoh{at}amc.seoul.kr

Abstract

Background Over a few months in the spring of 2011, a cluster of patients with severe respiratory distress were admitted to our intensive care unit (ICU). Household clustering was also observed. Extensive laboratory investigations failed to detect an infectious cause.

Methods Clinical, radiological and pathological investigations were conducted and the Korean Center for Disease Control performed epidemiological studies.

Results The case series consisted of 17 patients. Their median age was 35 (range 28–49) years. Six were pregnant at presentation and four had given birth 2 weeks previously. All presented with cough and dyspnoea. In the majority of patients (14/17), multifocal areas of patchy consolidation were identified in the lower lung zones on the initial CT. As the condition progressed, the patchy consolidation disappeared (10/13) and diffuse centrilobular ground-glass opacity nodules started to predominate and persist. Pathological specimens (11/17) showed a bronchiolocentric, temporally homogenous, acute lung injury pattern with sparing of the subpleural and peripheral alveolar areas. Ten patients required mechanical ventilation, eight of whom subsequently received extracorporeal life support. Four of the latter underwent lung transplantation. Five of the six patients in the ICU who did not receive lung transplantation died. An epidemiological investigation revealed that all patients had used humidifier disinfectants in their homes.

Conclusions This case series report showed that lung injury and respiratory failure can occur as a result of inhaling humidifier disinfectants. This emphasises the need for more stringent safety regulations for potentially toxic inhalants that might be encountered in the home.

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