CASE OF CHRONIC EOSINOPHILIC PNEUMONIA IN A PREGNANT PATIENT

Abstract

<h3>Introduction</h3> Chronic eosinophilic pneumonia (CEP) is an idiopathic pulmonary disease with abnormal eosinophil accumulation within the lung. Diagnostic criteria include prolonged respiratory symptoms (such as cough, dyspnea and wheezing), eosinophilia within the lungs/blood and abnormal chest imaging, without evidence of other etiologies of eosinophilic pneumonia. <h3>Case Description</h3> A 26 year-old female was diagnosed with CEP at 23 years of age after presenting with worsening symptoms of severe persistent asthma. Bronchoalveolar lavage fluid showed elevated eosinophil count and imaging showed pulmonary ground glass opacities. The patient was treated with oral corticosteroids, inhaled corticosteroids, montelukast and fexofenadine. She was a candidate for mepolizumab, but had become pregnant; therefore, biologic therapy was held. During the beginning of her pregnancy, peak flow was 457 l/min. Her oral steroid therapy was initially weaned; however, the dosing was increased towards the end of pregnancy due to worsening symptoms. Peak flow by the third trimester of pregnancy was 300 l/min. Her pregnancy was complicated by placental abruption; she received steroid stress dosing prior to C-section delivery. There were no reported postoperative complications to the patient or her child. Her peak flow had increased to 500 l/min one month after delivery. She began biologic therapy with mepolizumab 9 months after delivery, along with steroid tapering, with good response. <h3>Discussion</h3> While CEP is an increasingly studied entity, pregnancy in the setting of a known CEP diagnosis is not well documented. Management of such patients is challenging in view of their uncontrolled obstructive airways symptoms and systemic steroid requirement.