A clinical analysis of five cases of biopsy proven chronic eosinophilic pneumonia and review of literature

Abstract

Objective To analyze the clinical features,diagnosis,and treatment of chronic eosinophilic pneumonia (CEP).Methods The clinical data of five patients with biopsy-proven CEP from August 2005 to April 2012 in Chinese PLA general hospital were retrospectively analyzed,and the literatures were reviewed.Results The patients were all female,with mean age of (49.0 ± 9.1) years.The main clinical manifestations included cough (5/5),sputum production (5/5),dyspnea (2/5),fever (2/5),acratia (2/5),hemoptysis (1/5),and weight lost (1/5).The respiratory signs consisted of rales (2/5) and wheezes (1/5).In these cases,the percentage of peripheral blood eosinophil count was 1 ％ ～26.3％,with the median of 12.8％.The total serum IgE level of four patients was 20.1～3 440.0 IU/ml,with the median of 1 046.0 IU/ml.The chest CT scan mainly demonstrated patchy consolidation with peripheral predominance (5/5).The pulmonary histological examination showed alveolar and interstitial inflammation with predominance of eosinophils.The interval from onset of symptoms to diagnosis was (7.6±6.6) months.Before the diagnosis of CEP,they had been misdiagnosed as bacterial pneumonia (4/5),tuberculosis (3/5),atelectasis (2/5),allergic bronchopulmonary aspergillosis (1/5),and lung cancer (1/5).Four patients were treated with corticosteroids.In the follow-up of three patients,symptoms dramatically regressed,and the consolidation opacities of CT scan were seen absorption.Two patients relapsed after stopping corticosteroid therapy,however,respond was very well on resumption of corticosteroid treatment.Conclusions The clinical manifestation of CEP is insidious,which makes it usually be misdiagnosed.CEP should be considered when a patient has a history of cough,fever,and dyspnea over two weeks,with presence of peripheral eosinophilia and (or) alveolar eosinophilia,and the characteristic chest radiographic appearance of peripheral infiltrates with consolidation opacities,especially when the treatment of antibiotics is not useful.Glucocorticoid has a dramatic effect in treatment of CEP,but relapse is often seen when corticoid therapy is stopped too early. Key words: Chronic eosinophilic pneumonia; Pathology; Diagnosis; Treatment; Relapse