Background: Lycopodium powder consists of dried spores of club moss plants, principally Lycopodium Clavatum which is flammable when in contact with air due to its high oil content. Case presentation: A 15-year-old, previously healthy, female student presented to the Emergency Department with a 1-hour history of shortness of breath following accidental inhalation of Lycopodium in school. The dyspnoea was rapidly progressive and associated with multiple episodes of non-productive cough, chest tightness and nausea. A portable chest x-ray showed opacified bronchi in the right lower lung with para hilar peribronchial prominence virtually indistinguishable from those seen in lower respiratory tract infection. She began desaturating on 15L of oxygen and was unable to tolerate NIPPV (non-invasive positive pressure ventilation) hence shifted to the ICU where a 3L nasal cannula was started, which was well tolerated. IV Methylprednisolone was started at 40 mg q6h and was tapered to q8h the next day. The patient clinically improved and was stable by day 6. Conclusions: An extremely rare case of Lycopodium inhalation by a school student led us to realize not only the importance of a thorough history in cases where presentations can overlap but also safety recognition during school laboratory training sessions.

Keywords: Lycopodium, pneumonitis, NIPPV (non-invasive positive pressure ventilation), case report