Chronic Eosinophilic Pneumonia in a Cardboard Factory Worker With Inadequate Response to Prednisone

Abstract

SESSION TITLE: Student/Resident Case Report Poster - Occupational and Environmental Lung Diseases SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Occupation related exposures in paper and pulp factory workers have been implicated in chronic bronchitis, asthma, and general symptoms of breathlessness. Symptoms have been attributed to exposure to paper dust as well as non-organic chemicals. We describe a case of chronic eosinophilic pneumonia (CEP) in a patient with prolonged employment at a cardboard factory. CASE PRESENTATION: A 62 year old male with 25 year history of working in a cardboard factory presented with complaints of dyspnea, cough, malaise. He has been symptomatic for 20 years but was diagnosed with asthma and treated with albuterol with poor control and frequent recurrence. Exam revealed bilateral rales. Computer tomography (CT) of the chest showed extensive upper lobe pulmonary interstitial and alveolar lung disease. Bronchoalveolar lavage (BAL) showed intense eosinophilia (99%) and pathology exam of wedge resection of right middle lobe was consistent with CEP with features of organizing pneumonia. Prednisone 40mg daily was started but tapered to 20 mg over 6 months with continued employment. He began requiring oxygen at 3 L/min, received short term disability, and stopped working. 4 months later, a repeat CT showed stable ground glass opacities and increased interstitial markings. Spirometry revealed FEV1 49%, FVC 45%, and DLCO was 29% predicted. BAL demonstrated persistent yet improved eosinophilia (30%). DISCUSSION: Patients with CEP improve quickly with systemic steroids and exposure avoidance. Our patient had poor response to prednisone which could be attributed to his continued work-related exposure. We hypothesize that even after exposure cessation the additional pathology of organizing pneumonia likely contributed to poor steroid responsiveness. CONCLUSIONS: Our aim is to describe a case of refractory chronic eosinophilic pneumonia probably caused by prolonged non-organic chemical and paper dust exposures from working in a cardboard factory. Reference #1: Westberg H, Elihn K, Andersson E, Persson B, Andersson L, Bryngelsson IL, Karlsson C, Sjögren B. Inflammatory markers and exposure to airborne particles among workers in a Swedish pulp and paper mill. Int Arch Occup Environ Health. 2016 Feb 13. Reference #2: Arakawa H, Kurihara Y, Niimi H, Nakajima Y, Johkoh T, Nakamura H. Bronchiolitis obliterans with organizing pneumonia versus chronic eosinophilic pneumonia: high-resolution CT findings in 81 patients. AJR Am J Roentgenol. 2001 Apr;176(4):1053-8. Reference #3: Murgia N, Torén K, Kim JL, Andersson E. Risk factors for respiratory work disability in a cohort of pulp mill workers exposed to irritant gases. BMC Public Health. 2011 Sep 6;11:689. DISCLOSURE: The following authors have nothing to disclose: Kirill Lipatov, Tasnim Lat, Rachael Pattison, Darwin Ashbaker, Shekhar Ghamande No Product/Research Disclosure Information