When even too many apples can kill!
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Kaushalendra Tripathi
When even too many apples can kill!
CASE :A 55-year-old farmer was admitted to Rangueil Hospital,Toulouse, due to unstable angina. The chest x-ray film displayed diffuse micronodules, more numerous in the axillary and apical areas, with no lymph node inflammation . There were no functional respiratory symptoms. Results of standard biological tests and pulmonary function tests were within their normal range limits. Etiologic investigations were a lost cause . Coronary failure caused sudden death , and an autopsy was carried out .

FINDINGS :The pleura presented numerous whitish strands surrounded by anthracotic dust particles ; the pulmonary cut surface revealed granulomas within the parenchyma. On thoracic incision, the pleura presented numerous whitish strands surrounded by anthracotic dust particles ;the pulmonary cut surface revealed granulomas within the parenchyma. Light microscopy displayed deposits of a crystallized lipid, found in macrophages and large multinucleated cells in the interlobular septa, subpleuraal and peribronchial tissue certain level of deposition intltration by mononuclear elements developed with cicatricial fibrosis.
Electron microscopy showed that these crystals were also present in the cytoplasm of the septal and alveolar macrophages, but not in the endothelial and alveolar epithelial cells .Numerous identical crystals were found in the abdominal lymph nodes, and to a lesser extent in the liver, spleen,
inferior tracheobronchial lymph nodes and adrenal glands.
Histochemical study excluded the possibility of an endogenous lipid more specifically cholesterol-ester granulomatosis. Mass spectrometry revealed the molecular formula as corresponding to saturated hydrocarbons (n-alkanes), these hydrocarbons are present in animal and
vegetal waxes.
This result led them to pursue the case history with the help of the family, and revealed heavy consumption off foods naturally containing these hydrocarbons.
For 18 years, the subject had daily ingested I kg of apples, and also, to a lesser extent, he ate Brussels sprouts three
times a week during the winter.
It was through the study of case history together with chemical tests of the products that eliminated the possibility of intoxication concluding the storage of n-alkanes was due to the excessive consumption of apples (as he had consumed 4-6 apples a day)
As far as the study was concerned no case of lipid pneumonia has previously been linked with intestinal absorption at the time, although it was not suprising that ingested hydrocarbons are partially absorbed and found in the ductus lymphaticus, the liver, the spleen and the lymph nodes. Moreover, the role of the lung in the retention of lipids, and in particular of chylomicrons, has been clearly demonstrated.

CONCLUSION :Though the nature and source of entry are extremely unusual in this case, pulmonary lesions originate in the same way as in other lipid pneumonias: the lipid-laden macrophages migrate along the lymphatic channels, and their
disintegration causes a foreign body reaction with multinucleated cells and peripheral fibrosis. The crystallized
appearance of the lipid we observed was due to the molecular
weight, higher than that of the oils usually found in exogenous
lipoid pneumonias. The microscopic appearance is
comparable with that of cholesterol-ester pulmonary granulomas, The coronary stenosis to which death was attributed appeared to be due to banal atheromatous lesions, unconnected with the hydrocarbon deposition.

SOURCE ARTICLE :https://www.ncbi.nlm.nih.gov/pubmed/3757573
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