A clear case of chronic aspiration of starch (potato) Alessandro Andreani 1 , Gaia Cappiello 1 , Michele Valli 1 , Elisa Businarolo 1 , Rosita Melara 1 , Michele Giovannini 1 and Giulio Rossi 2 1 Department of Respiratory Diseases, St Maria Bianca Hospital, Mirandola, Italy 2 Department of Pathologic Anatomy, Azienda Policlinico, Modena, Italy Abstract One of the known agent that causes an organizing pneumonia could be the chronic inhalation of food, but generally we can’t find the specific food that caused this pattern. We show a case where, with an accurate medical history, supported by the various histological investigation steps, we could reach the specific cause of it. Please cite this paper as: Andreani A, Cappiello G, Valli M, Businarolo E, Melara R, Giovannini M and Rossi G. A clear case of chronic aspiration of starch (potato). Clin Respir J 2013; 7: 416–418. Key words chronic inhalation – organizing pneumonia – pathology – starch – transbronchial biopsies Correspondence Alessandro Andreani, MD, Department of Respiratory Diseases, Hospital St Maria Bianca, 41037 Mirandola (Modena), Italy. Tel: +39 347 0381277, +39 59 8385371, +39 535 602289 Fax: +39 535 602538 email: alessandreani@yahoo.it; a.andreani@ausl.mo.it Received: 03 December 2012 Revision requested: 08 March 2013 Accepted: 21 March 2013 DOI:10.1111/crj.12021 Authorship and contributorship We confirm that all authors have made a substantial contribution to the information or material submitted for publication, and that all have read and approved the final version for submission to The Clinical Respiratory Journal. Conflict of interest No potential conflict of interest exists. Case history In June 2011, a 74-year-old nonsmoker woman came to our attention complaining for months of dyspnea and dry cough resistant to nonspecific antibiotic therapy (amoxicillin/clavulanic acid and levofloxacin, prescribed by her physician, for 10 days). She had no history of respiratory diseases; she had instead history of cerebri stroke (in March 2006), without neu- rological outcome, and throat cancer treated with radiotherapy 10 years before. When she came to our attention, physical examination showed dry crackles bilaterally in the lower lung fields. Pulmonary function test showed a mild restrictive respiratory pattern while the pulse oximeter showed an oxygen saturation of 95% at rest. The patient underwent firstly chest radio- graph then thoracic computed tomography, which showed the presence of diffuse bilateral opacities, espe- cially in the lower lobes (Fig. 1A, B). We then per- formed bronchoscopy with transbronchial biopsies, guided by fluoroscopy, in the right lower lobe; histo- logical analysis deposed for organizing pneumonia with giant cells which presented in their cytoplasm exogenous birefringent bodies (Fig. 1C); the patho- logist assumed that this pattern could be typical in chronic aspiration of talcum powder. The patient denied the use or exposure to talcum powder so the pathologist compared the microscopic appearance of The Clinical Respiratory Journal CASE REPORT 416 The Clinical Respiratory Journal (2013) • ISSN 1752-6981 © 2013 John Wiley & Sons Ltd