Case Of Eosinophilic Pneumonia Research Articles

A Case of Eosinophilic Pneumonia During Treatment for Combined Pulmonary Fibrosis and Emphysema

A Case of Eosinophilic Pneumonia During Treatment for Combined Pulmonary Fibrosis and Emphysema

A Case of Eosinophilic Pneumonia in a Patient Receiving Dupilumab Therapy

A Case of Eosinophilic Pneumonia in a Patient Receiving Dupilumab Therapy

A Case of Eosinophilic Pneumonia After Immune Checkpoint Inhibitor Treatment Following Concurrent Chemoradiotherapy

A Case of Eosinophilic Pneumonia After Immune Checkpoint Inhibitor Treatment Following Concurrent Chemoradiotherapy

Eosinophilic pneumonia in allergological practice

In this article, current data on pulmonary eosinophilia are presented. Pulmonary eosinophilia is defined as the infiltration of eosinophils into the airways, interstitia, and alveoli. There are diverse processes in etiology, the common feature of which is the presence of pulmonary eosinophilic infiltrates, and as a rule, peripheral blood eosinophilia. Causes of pulmonary eosinophilia include various infections, medications, parasites, autoimmune processes, malignancies, and presence of obstructive pulmonary diseases. A unified classification of pulmonary eosinophilia is lacking, and instead, various versions of classifications have been presented. The most convenient classification option for use is also distinguished. This article discusses the historical transformation of the term eosinophilic pneumonia in the field of allergology, showing the lack of unambiguity in the concept of eosinophilic pneumonia, as well as the location of eosinophilic pneumonia in the pulmonary eosinophilia section. Eosinophilic pneumonia is defined as a disease characterized by an increase in the eosinophil content in the pulmonary tissue or bronchoalveolar lavage fluid. Most eosinophilic pneumonias are associated with peripheral blood eosinophilia. Two main variants of the disease are acute and chronic eosinophilic pneumonias. Thus, various ways to formulate diagnoses in various cases of eosinophilic pneumonia have been proposed.

A Case of Eosinophilic Pneumonia Caused by Hachimijiogan in Which Bronchoalveolar Lavage Was Useful for Differentiating Pulmonary Amiodarone Toxicity

A Case of Eosinophilic Pneumonia Caused by Hachimijiogan in Which Bronchoalveolar Lavage Was Useful for Differentiating Pulmonary Amiodarone Toxicity

A CURIOUS CASE OF GRANULOMATOUS INFLAMMATION OF THE LUNG

SESSION TITLE: Medical Student/Resident Tobacco Cessation and Prevention Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Young patients may have a multitude of causes for incidental lung lesions. Granulomatous lung lesions are frequently associated with infections, less common causes such as toxin mediated and vasculitis should be ruled out. We present the case of a patient who presented with granulomatous nodules due to water pipe smoking (WPS). CASE PRESENTATION: 21 year-old female presented with chest pain and dyspnea. She reported a 3-year history of tobacco use in the form of WPS and a remote history of vaping. Chest x-ray revealed a right middle lobe infiltrate concerning for pneumonia which was treated with antibiotics. CT chest further characterized the lesion as a 4 cm mass with additional clusters of irregular sub-centimetre nodules with subcarinal and mediastinal lymphadenopathy (Fig 1). Bronchoscopy showed large endobronchial lesions and histology showed necrotizing granulomas with negative stains and cultures for fungal or tuberculosis or evidence of malignancy. lymph node biopsy tissue samples demonstrated necrotizing granulomas. The patient was subsequently discharged from the hospital for outpatient management with a brief course of corticosteroids and was lost to follow up thereafter. DISCUSSION: Our patient who presented with an incidental lung lesion on her radiographs was found to have granulomatous lung nodules on histology. Workup remained negative for common causes such as Fungal infections, Tuberculosis or malignancy and she was eventually presumed to have WPS induced granulomatous lung disease given her prolonged and recent exposure. WPS as a trend has been silently picking up among certain young adult populations in the West with some studies indicating usage rates as high as 46.4% among college students. Contents in water pipe smoke such as ultrafine particulate matter (PM), carcinogenic particles and heavy metals have been implicated in a host of lung pathologies ranging from emphysema to infections and even lung cancers. Granulomatous inflammation however remains an infrequent complication and the mechanism underlying this pathology has yet to be elucidated. Such a finding has only been reported once before by Dyal et al who described the case of a young female with bilateral granulomatous secondary to WPS who was treated successfully with steroids, suggesting a component of underlying inflammation. CONCLUSIONS: Detailed and updated review could help strengthen evidence for the truly disastrous effects of WPS on long term health of our young adults, and potentially support litigation for the ban on sale and use of these products, as was accomplished recently in case of E-cigarettes or vaping. Reference #1: American Lung Association. Hookah smoking: a growing threat to public health [accessed 2016 Apr 9] Reference #2: Shafagoj Y.A., Mohammad F.I. Levels of maximum endexpiratory carbon-monoxide and certain cardio vascular parameters following hubble-bubble smoking. Saudi. Med. J. 2002;23:953958 Reference #3: Dyal H, Singhvi A, Patel R, et al. 2014. A case of Eosinophilic pneumonia following recent onset of hookah smoking. Chest 146:406A DISCLOSURES: No relevant relationships by Sanjay Dogra, source=Web Response No relevant relationships by Sandeep Kumar, source=Web Response No relevant relationships by Shaiva Meka, source=Web Response No relevant relationships by Syed Mustafa, source=Web Response No relevant relationships by Ehsun Naeem, source=Web Response

Eosinophilic pneumonia induced by non-steroidal anti-inflammatory drugs: An underestimated risk

Eosinophilic pneumonia (EP) is a rare but serious adverse drug reaction (ADR) induced by non-steroidal anti-inflammatory drugs (NSAIDs). We describe the second published case of EP induced by oral diclofenac. We also reviewed the literature as well as French pharmacovigilance database. Case presentation A 63 year-old woman with polyarthralgia had taken diclofenac for three days for analgesic purposes. Progressively, the patient presented weakness, dyspnea and fever. Computed tomography (CT) scan revealed bilateral interstitial infiltration. Broncho-alveolar lavage (BAL) showed an elevated level of eosinophils. After ruling out all other possible etiologies, drug-induced EP was diagnosed and treatment by corticosteroid was initiated. The patient recovered in three months. In the French pharmacovigilance database, six cases of EP were recorded (3 with naproxen, 2 with ibuprofen, 1 with piroxicam). In the literature, twenty-six cases of EP with NSAIDs were published. The most commonly involved drug was naproxen (n=8), followed by fenbufen (n=4), ibuprofen (n=3) and diclofenac (n=2). A high level of eosinophils was systematically observed in the blood cell count or BAL. Corticosteroid therapy was started in eleven cases. All patients recovered. Complete history taking and examination should be done to rule out other etiological diagnoses. BAL is sufficient to diagnose EP. Corticosteroid therapy should be indicated for more severe or refractory cases. This adverse drug reaction is underestimated, healthcare professionals should be informed.

DISC: Describing Infections of the Spine treated with Ceftaroline.

Infections of the spine lead to considerable morbidity and a high cost to the global healthcare system. Currently, evidence for using ceftaroline, an advanced-generation cephalosporin active against methicillin-resistant Staphylococcus aureus (MRSA), in spine infections is limited. Describing Infections of the Spine treated with Ceftaroline (DISC) is a multicentre, retrospective, cohort study that evaluated ceftaroline for treating spine infections. Patients were included if they were aged ≥18 years, diagnosed with a spine infection and treated with ceftaroline for ≥28 days. A control group was identified with the same inclusion criteria as the study population except they were treated with a comparator antibiotic for ≥28 days. Thirty-seven patients were included each in the ceftaroline and control groups. MRSA was the most commonly identified pathogen. With no differences between groups in age, sex, race or co-morbidities (with the exception of chronic kidney disease), treatment with ceftaroline led to similar clinical success compared with the control group. Multivariate regression analysis did not show a significant difference between the two groups in terms of clinical success after controlling for other covariates (adjusted odds ratio=1.49; P=0.711). More patients who received ceftaroline were discharged to an extended-care or rehabilitation facility than home compared with controls (81% vs. 54%, respectively; P=0.024). Side effects and toxicities were rare, including one case of eosinophilic pneumonia in the ceftaroline group. Ceftaroline appears to be a safe and effective therapy for infections of the spine, including from MRSA.

Pneumopathie à éosinophiles chez un patient atteint de psoriasis en plaques traité par ustékinumab

Ustekinumab (Stelara(®)) is efficacious in severe cutaneous psoriasis. Numerous adverse effects have been reported but treatment withdrawal is rarely required. The present case concerns eosinophilic pneumonia treated with ustekinumab. A 71-year-old male patient presented severe plaque psoriasis with an indication for biotherapy. Pre-treatment investigations showed a highly positive interferon gamma test without any anomalies in the CT chest scan. The patient was treated with anti-tuberculosis agents and ustekinumab was then introduced. Seven months later, the patient presented a cough resistant to antibiotics. A CT scan showed frosted-glass-like shadows and mediastinal lymphadenopathy. The bronchoalveolar lavage fluid contained 800elements/mm(3), of which 34% eosinophils. There were 1480G/L eosinophils in peripheral blood. There was nothing evocative of infectious or tumoral causes, and a diagnosis of eosinophilic pneumonia was made. Ustekinumab was stopped and 10weeks later, the patient's condition worsened; after further examination, systemic corticosteroids were given, beginning with prednisone 1mg/kg. Seven months later, the patient was symptom-free, without eosinophilia, and his chest scan was normal. The corticosteroids were stopped. Eosinophilic pneumonia includes various disorders characterized by eosinophilic infiltration of lung tissue, with or without the presence of eosinophils in peripheral blood. Eosinophilic pneumonia can be caused by many different drugs. Diagnosis is difficult because clinical and radiological abnormalities may develop at different times after treatment initiation and they are non-specific. A favourable outcome may occur spontaneously on treatment withdrawal or a short course of corticosteroid therapy may be needed. A case of eosinophilic pneumonia under ustekinumab has already been reported, supporting the causal involvement of this drug in our patient. Eosinophils in peripheral blood have also been reported with anti-TNF-alpha. In conclusion, where a patient on biologic treatment for psoriasis presents persistent cough, once infectious disease has been ruled out, eosinophilic pneumonia should be considered.

A Case of Eosinophilic Pneumonia Following Recent Onset of Hookah Smoking

A Case of Eosinophilic Pneumonia Following Recent Onset of Hookah Smoking

Eosinophilic pneumonia induced by ceftaroline

A case of eosinophilic pneumonia in a patient receiving ceftaroline for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is reported. A 65-year-old woman was admitted to a medical intensive care unit after arriving at the emergency room with complaints of progressively worsening shortness of breath. Her medical history included chronic obstructive pulmonary disease, acute respiratory distress syndrome, recent traumatic brain injury, tobacco use, and alcohol abuse. Within the first few days of hospitalization, the patient was diagnosed with MRSA pneumonia based on microbiological data from bronchoscopy bronchial washings. Her renal function liver enzyme levels were within normal limits. Empirical antibiotic therapy included i.v. vancomycin and meropenem and was narrowed to i.v. linezolid monotherapy based on culture and sensitivity results. After 10 days of treatment with linezolid, the patient was persistently febrile, and cultures remained positive. It was decided to switch therapy to a course of i.v. ceftaroline, an anti-MRSA cephalosporin. On the fifth day of treatment with ceftaroline, the patient developed respiratory decompensation and peripheral eosinophilia of 40%. Bronchoalveolar lavage (BAL) results indicated the presence of pulmonary eosinophilia of 13%. Chest radiographs revealed pulmonary infiltrates, and the computed tomography angiography showed no evidence of pulmonary embolism. Ceftaroline was discontinued, and the patient was started on vancomycin and methylprednisolone. The patient responded to methylprednisolone therapy, with repeat BAL and peripheral blood counts showing resolved eosinophilia. A patient with risk factors for respiratory disease developed eosinophilic pneumonia after receiving ceftaroline for the treatment of MRSA pneumonia. Eosinophilia resolved after ceftaroline was discontinued and i.v. methylprednisolone was initiated.

肺癌術後loxoprofen内服にて発症した好酸球性肺炎の1例

症例は75歳，男性．Stage I A肺癌に対し右下葉切除術+縦隔リンパ節郭清術（ND2a-2）を施行し，第1病日から疼痛管理としてloxoprofen 180mg/日を内服していた．第12病日に乾性咳嗽と労作時呼吸困難を自覚，低酸素血症を認め，背部で捻髪音を聴取した．経気管支肺生検にて肺胞隔壁への好酸球浸潤を確認した．薬剤誘発性リンパ球刺激試験ではloxoprofenが陽性であった．Loxoprofenによる薬剤性の好酸球性肺炎と診断しその服用を中止したところ，次第に症状は軽快した．Steroidは使用しなかった．術後に咳嗽，労作時呼吸困難，びまん性陰影の出現がみられた際には薬剤性好酸球性肺炎も鑑別にあげる必要がある．

Eosinophilic Pneumonia in Patients Treated with Daptomycin

Eosinophilic pneumonia (EP) has been noted in association with daptomycin use. The product labelling was recently updated to include EP in the Warnings and Precautions and Post-Marketing Experience sections. The objective of this study was to analyse adverse event (AE) reports submitted to the US FDA as well as published cases to characterize the clinical features and course of EP in daptomycin-treated patients. We searched for EP cases associated with daptomycin administration in the FDA Adverse Event Reporting System (AERS) submitted from 2004 to 2010, and the published literature. Cases were defined as definite, probable, possible and unlikely in terms of the diagnosis of EP and the potential association with daptomycin exposure. Definite cases had concurrent exposure to daptomycin, fever, dyspnoea with increased oxygen requirement or required mechanical ventilation, new infiltrates on chest imaging, bronchoalveolar lavage with >25% eosinophils and clinical improvement following daptomycin withdrawal. Additionally, we assessed inpatient daptomycin utilization. We identified 7 definite, 13 probable, 38 possible cases of daptomycin-induced EP, and 23 unlikely cases. The seven definite EP cases had resolution after daptomycin was stopped, including two with EP recurrence following daptomycin rechallenge. Regarding the definite cases: (i) ages ranged from 60 to 87 years; (ii) dosing ranged from 4.4 to 8.0 mg/kg/day; and (iii) EP developed 10 days to 4 weeks after starting daptomycin. There was a gradual increase in the number of patients with an inpatient hospital discharge billing for daptomycin from the year 2004 to 2010. We report 7 definite, 13 probable and 38 possible EP cases associated with daptomycin administration. As AERS is based on voluntary reporting, the incidence of EP cannot be assessed. Healthcare providers should have heightened awareness of this serious AE associated with daptomycin use.

A Case of Eosinophilic Pneumonia in a Tobacco Harvester

Eosinophilic pneumonia comprises a group of lung diseases in which eosinophils appear in increased numbers in the lungs. The distinct etiology of eosinophilic pneumonia is unknown, although the previous case series have indicated a relationship between acute eosinophilic pneumonia and the exposure to exogenous substances including the constituents of cigarettes. A 60-year-old nonsmoking female, who had started to harvest and sort tobacco leaves two months before presentation, was admitted because of persistent coughing, breathlessness, and general malaise. Her laboratory findings revealed eosinophilia. Chest computed tomography showed nonsegmental airspace consolidations bilaterally. A bronchoalveolar lavage fluid analysis also revealed that the numbers of total cells and eosinophils had increased. Although the urine level of cotinine was within the normal range, positive findings were found in the skin scratch-patch tests using tobacco leaf and its extracts, and a biopsy specimen obtained from the positive site demonstrated infiltration of eosinophils in the dermis. The patient was successfully treated with corticosteroids. Green tobacco sickness, a type of nicotine poisoning caused by the dermal absorption of nicotine, is a well known occupational illness of tobacco harvesters. Although it is unclear whether the present case could be identified as a subtype of green tobacco sickness, this is the first report of eosinophilic pneumonia occurred in a tobacco harvester which was possibly induced by tobacco leaf exposure.

Eosinophilic pneumonia associated with bleomycin in a patient with mediastinal seminoma: a case report

IntroductionLung toxicities resulting from the chemotherapeutic agent bleomycin encompass a variety of pathological changes, including bronchiolitis obliterans organizing pneumonia, interstitial pneumonitis and progressive interstitial fibrosis. We report a rare case of eosinophilic pneumonia associated with bleomycin.Case presentationA 44-year-old Hispanic man with a primary mediastinal seminoma complicated by superior vena cava syndrome underwent treatment with four cycles of bleomycin, etoposide and cisplatin. He had a complete positive response to the chemotherapy. However, three months after treatment he presented with shortness of breath and severe hypoxemia associated with peripheral eosinophilia. Computed tomography showed bilateral diffuse interstitial infiltrates that were refractory to antibiotic treatment. A lung biopsy showed eosinophilic pneumonia. He was subsequently treated with high-dose prednisone, resulting in a complete resolution of his symptoms and lung infiltrates.ConclusionThis case illustrates that eosinophilic pneumonia may be a late sequela of bleomycin toxicity, and may respond dramatically to steroid treatment.

A Case of Pneumocystis Pneumonia Mimicking Acute Eosinophilic Pneumonia in a Patient with AIDS

A 73-year-old man was admitted with a sudden onset of dyspnea. He had never smoked. The chest radiograph and computed tomography revealed bilateral ground glass opacity and an enlarging perihilar consolidation with lymphadenopathies. There was a higher percentage of eosinophils (72%) in the bronchoalveolar lavage fluid (BALF) than normal. The patient was diagnosed with acute eosinophilic pneumonia and managed with steroid. Pneumocystis pneumonia (PCP) was diagnosed by an examination of the BALF, and the patient was treated with trimethoprim-sulphamethoxazole. The patient tested positive to the HIV antibody and the peripheral blood CD-4 positive lymphocyte count was only 33/μL. The percentage of eosinophils in the BALF can increase in some cases of PCP that is complicated with AIDS. Only a few cases of eosinophilic pneumonia associated with PCP pneumonia have been reported in patients with AIDS but there are no case reports in Korea. This case highlights the need to consider PCP when the percentage of eosinophils in the BALF is elevated.

A Case of Eosinophilic Pneumonia with Ibuprofen as the Suspected Etiology

Eosinophilic lung diseases are heterogenous disorder which are characterized by the presence of pulmonary symptoms or an abnormal chest radiograph accompanied by inflammatory cellular infiltrates in the airways and lung parenchyma which contain large numbers of eosinophils. The incidence of drug-induced pulmonary disorder is increasing, with at least 40 drug entities having been reported to cause this pulmonary disease. However, nonsteroidal anti-inflammatory drugs (NSAIDs) are rarely mentioned in the lists of drugs in published articles describing drug induced eosinophilic pneumonia. The following is a case of eosinophilic pneumonia that we believe was related to ibuprofen therapy. (Tuberculosis and Respiratory

A Case of Mesalazine-induced Eosinophilic Pneumonia in a Patient with Ulcerative Colitis

Mesalazine(5-Aminosalicylic acid,5-ASA), a component of Sulfasalazine (sulfapyridine bound to 5-ASA), is used to treat inflammatory bowel disease. Most adverse pulmonary effects caused by sulfasalazine have been attributed to sulfapyridine. However, lung toxicity associated with mesalazine(5-ASA) is rare. Here we report a case of eosinophilic pneumonia in a 44-year-old woman with ulcerative colitis, who was treated with mesalazine. She developed symptoms of a dry cough, mild night fever, and exertional dyspnea. Bilateral peripheral pulmonary infiltrates, peripheral blood eosinophilia, and histologic features were consistent with eosinophilic pneumonia. The symptoms improved quite rapidly after the discontinuation of mesalazine and initiation of steroid therapy. Therefore, adverse pulmonary reactions to mesalazine must be considered in a differential diagnosis of pulmonary involvement in patients with inflammatory bowel disease who are receiving with mesalazine therapy.

A Case of Eosinophilic Pneumonia and Vasculitis Induced by Diflunisal

Drug-induced pneumonitis is an uncommon complication of nonsteroidal anti-inflammatory drug administration. Herein is the first reported case of pneumonitis resulting from diflunisal therapy. The patient demonstrated clinical and biopsy evidence of systemic vasculitis. She responded dramatically to administration of systemic glucocorticoids.

Eosinophilic pneumonia and respiratory failure associated with a trazodone overdose.

Drug-induced eosinophilic lung disease commonly presents as a simple pulmonary eosinophilia-like syndrome consisting of transient pulmonary infiltrates, peripheral eosinophilia, and mild pulmonary symptoms that disappear promptly upon withdrawal of the offending medication. However, a more fulminant presentation most resembling acute eosinophilic pneumonia has been recently described. We present a patient with BAL-confirmed eosinophilic pneumonia (EP) and respiratory failure after a trazodone overdose. This is the first case of EP associated with trazodone and only the third drug-mediated EP reported to precipitate respiratory failure.