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The images are electron microscopic images showing macrophages containing abundant neutral lipid droplets(a,b,f). There were only occasional multilamellar stuctures with surfactant (d,e) (not nearly enough to make it typical PAP) and extracellular debris, tubular myelin(d,e). There were also cholesterol clefts (c) within and outside the cell as highlighted in Figure 6g. The findings were not considered typical of PAP, but PAS positive material was seen in the macrophages. The impressive findings were suggestive of lipoid pneumonia.

He remained symptomatic after the lavage without the expected improvement that had been hoped. He developed a pulmonary infection (pseudomonas was isolated from his BAL) and he was treated with antibiotics. However, on or off the antibiotics, he remained febrile and his chest radiograph did not change. His antibiotics were discontinued.

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