IDIOPATHIC CHRONIC EOSINOPHILIC PNEUMONIA EVOLVING TO PULMONARY FIBROSIS: A RETROSPECTIVE ANALYSIS

Abstract

TOPIC: Diffuse Lung Disease TYPE: Original Investigations PURPOSE: Some patients with idiopathic chronic eosinophilic pneumonia (ICEP) may develop pulmonary fibrosis. This study was conducted to investigate the predictors of fibrosis developing in patients with ICEP. METHODS: A retrospective, computer-assisted search was performed to identify patients with ICEP seen at Mayo Clinic, Rochester from 1997-2019. Those patients who had follow-up chest CT beyond 12 months after the ICEP diagnoses were included in the study. Demographics, clinical, radiologic, and histopathologic features were analyzed. Proportional hazards regression was used to assess the predictors of pulmonary fibrosis. RESULTS: We identified 68 patients; mean±SD age at the time of ICEP diagnosis was 56.4±13.2 years, 60% female. Cough (87%) followed by shortness of breath (84%) and wheezing (35%) were the most common presenting symptoms. 41% had history of smoking and 46% had history of asthma. During follow-up 29 patients (43%) developed CT evidence of pulmonary fibrosis; 76% of these patients had a CT pattern inconsistent with usual interstitial pneumonia (UIP) pattern. The CT evidence of pulmonary fibrosis developed within 2 years after the diagnosis of ICEP in the majority of these patients. Age, body mass index (BMI) and male sex were the predictors of pulmonary fibrosis. On the other hand, history of asthma decreased the likelihood of developing pulmonary fibrosis. CONCLUSIONS: Development of pulmonary fibrosis is not uncommon in patients with ICEP, especially in older males with high BMI, and is associated with an increased risk of mortality. CLINICAL IMPLICATIONS: The clinical implication of our study is to recognize this phenomenon and to keep following up patients with ICEP especially those with risk factors for pulmonary fibrosis. Early institution of prednisone should be considered. DISCLOSURES: No relevant relationships by Misbah Baqir, source=Web Response No relevant relationships by Tucker Johnson, source=Web Response No relevant relationships by Tobias Peikert, source=Web Response No relevant relationships by Jay Ryu, source=Web Response No relevant relationships by Darrell Schroeder, source=Web Response No relevant relationships by Joanne Yi, source=Web Response