Abstract
Acute eosinophilic pneumonia (AEP) is characterized by an acute onset respiratory illness with bilateral chest infiltrates and evidence of pulmonary eosinophilia. Cigarette smoking is the main risk factor, but drugs and other inhalational exposures have also been reported. Herein, the association between AEP and smoking devices other than cigarettes is reviewed The PubMed database was searched using terms such as "smoking", "vaping", "e-cigarette", "waterpipe", and "marijuana", along with other commonly used synonyms for these terms. In addition, eosinophilic lung diseases were also searched for using the same database. All cases of AEP were identified using the modified Philit criteria in association with the use of marijuana, waterpipe, e-cigarettes or heat-not-burn cigarettes. Cases associated with illicit drug use were excluded. Twelve cases were included with amedian age of 20 (15-60). 75% of patients studied were male. Exposures included marijuana smoking (n = 5), waterpipe usage (n = 2), heat-not-burn cigarette use (n = 2), e-cigarette use (n = 2) and synthetic cannabinoid use (n = 1). Arecent change in smoking habits was reported in 50% of patients. Presenting symptoms were dyspnea (91.6%), cough (66.6%), fever (66.6%) and chest pain (25%). 90% of patients had leukocytosis on presentation, but only 16.6% had peri-pheral eosinophilia. The median eosinophil percentage in bronchoalveolar lavage was 67.5% (0 to 78). Two patients had alung biopsy performed. Bilateral involvement on chest imaging was reported in all patients. Five patients (41.6%) required invasive mechanical ventilation and ten patients (83.3%) were treated in an intensive care unit. All patients responded to corticosteroid therapy with no relapses reported. Acute eosinophilic pneumonia is reported with smoking that does not include traditional cigarette smoking such as waterpipes, e-cigarettes, heat-not-burn cigarettes, and marijuana and can have asimilar presentation and clinical course.
Highlights
Acute eosinophilic pneumonia (AEP) is an eosinophilic lung disease characterized by an acute onset febrile respiratory illness with bronchoalveolar lavage eosinophilia that promptly responds to treatment with steroids
With illicit drug use Patient characteristics and exposures Table 1 summarizes the reported cases and patient demographics. 12 cases of AEP linked to non-cigarette smoking were reported with the patients having a median age of 20. 42.6% were younger or equal to 18 years of age and 75% were male
A recent change in smoking habits was reported in 50% of patients and included the following: new initiation within 1 month in one patient, recent product change in four patients, and restarting less than 1 month in 3 patients
Summary
Acute eosinophilic pneumonia (AEP) is an eosinophilic lung disease characterized by an acute onset febrile respiratory illness with bronchoalveolar lavage eosinophilia that promptly responds to treatment with steroids. While the disease can be idiopathic, cigarette smoking is a major risk factor [1, 2] and commonly occurs in the setting of new exposure or a recent change in smoking habits [3, 4]. Drug use and other inhalational exposures are known triggers [5,6,7]. The reported cases of AEP in association with non-cigarette smoking such as e-cigarette, marijuana, and waterpipe smoking are reviewed
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