Diagnosis Of Chronic Eosinophilic Pneumonia Research Articles

EOSINOPHILIA AND DYSPNEA: NOT ALWAYS AN ASTHMA EXACERBATION

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Eosinophilia is a common laboratory finding in patients diagnosed with asthma, however combined with dyspnea and a chronic cough, other diagnoses can be overlooked.. Chronic eosinophilic pneumonia is characterized by a chronic and progressive course similar to worsening asthma with the addition of specific pathologic findings. Here we present a case of a patient with known asthma who presented with progressively worsening cough, shortness of breath and eosinophilia. CASE PRESENTATION: A 46-year-old male with a history of asthma presented to the emergency department (ED) with worsening shortness of breath at both rest and exertion for two months. The patient had associated wheezing, thick yellow sputum and rhinorrhea. At presentation he also noted a two-week history of night sweats with a ten pound weight loss. Prior to presentation the patient underwent a chest x-ray and was treated for two weeks with antibiotics. for presumed pneumonia. The patient then underwent a repeat chest x-ray and was subsequently referred for chest CT. In the ED the patient was noted to have leukocytosis of 34 K/uL with 23.2 K/uL eosinophils (68.2%) Chest X-Ray demonstrated patchy air-space opacities with a predominantly mid to upper lung zone distribution. The patient was started on methylprednisolone, ceftriaxone, and azithromycin for community acquired pneumonia and was seen by the pulmonary and infectious disease consultants. The patient was tested for angiotensin converting enzyme, P-ANCA, Aspergillus, HIV, and tuberculosis, all of which were negative. The patient clinically improved and antibiotic therapy was discontinued. Three days after admission a repeat CXR, showed improved bilateral pulmonary parenchymal abnormalities. The patient’s eosinophilia resolved within three days and the patient continued to clinically improve with a tapering course of steroid therapy. DISCUSSION: Chronic eosinophilic pneumonia (CEP)is characterized by chronic and progressive clinical features and specific pathological findings. The onset of CEP is generally insidious, either subacute or chronic. Accordingly, the symptoms often appear several months before the diagnosis is made. The diagnosis of CEP is based on the association of respiratory symptoms, alveolar or blood eosinophilia, a non-segmental pulmonary infiltration with peripheral predominance involving mainly the upper lobes on chest imaging and the exclusion of other eosinophilic lung diseases. Corticosteroid treatment results in rapid resolution of symptoms, radiologic opacities and peripheral eosinophilia as occurred in our case. CONCLUSIONS: This case demonstrates the need for physicians to broaden their differential diagnoses when considering the etiology of eosinophilia in patients with a history of asthma. Reference #1: https://www.uptodate.com/contents/chronic-eosinophilic-pneumonia?search=chronic%20eosinophilic%20pneumonia&source=search_result&selectedTitle=1∼37&usage_type=default&display_rank=1 DISCLOSURES: No relevant relationships by Jang Chadha, source=Web Response No relevant relationships by Yelenis Fuertes Yanes, source=Web Response No relevant relationships by Nida Hameedi, source=Web Response

Neumonía eosinofílica crónica

La neumonía eosinofílica crónica es una entidad poco frecuente y estudiada en nuestro medio, cuyo diagnóstico se basa inicialmente en la sospecha clínica y los antecedentes comunmente asociados como atopia o asma; sin embargo, no todos los casos se presentan como lo describe la literatura científica. Se expone el caso de un paciente previamente sano, con un cuadro crónico de tres meses de tos y síntomas constitucionales que no mejoraron a pesar de múltiples esquemas antibióticos de forma empírica y con persistencia de múltiples opacidades de compromiso alveolar con broncograma aéreo y áreas de consolidación de predominio basal bilateral. Se realizó fibrobroncoscopia y lavado broncoalveolar con evidencia de eosinofilia pulmonar, hallazgo que determinó el diagnóstico de neumonía eosinofílica crónica, sin realización de biopsia. Una de las pruebas para confirmar el diagnóstico es la respuesta a la terapia esteroidea, dejando como última opción las medidas invasivas.Un alto índice de sospecha clínica, la documentación de eosinofilia periférica y/o pulmonar y la respuesta al tratamiento con corticoides deberían ser suficientes para el diagnóstico definitivo de neumonía eosinofílica crónica, en los casos en los que no es posible realizar biopsia pulmonar.

Mediastinal vacuum phenomenon: atypical pneumomediastinum caused by gas replacement of diminished fat

We report a case involving an 83-year-old man with interstitial lung disease who developed atypical pneumomediastinum caused by gas replacement of diminished fat. The patient presented with a complaint of worsening symptoms of respiratory difficulty since a diagnosis of chronic eosinophilic pneumonia 5 months back. He had been under observation with no particular treatment for 5 months. Computed tomography performed on admission revealed pneumomediastinum. When the current scan was compared with that obtained 5 months ago, it was evident that the fat surrounding the mediastinum had been replaced by gas density. There was no mediastinal enlargement, pneumothorax, or pneumopericardium. Because the patient was elderly, home oxygen therapy was initiated for the interstitial pneumonia with no steroid therapy. Computed tomography performed 10 months after discharge showed the reappearance of mediastinal fat and no evidence of gas density. This case is unique because the pneumomediastinum was distinct from spontaneous pneumomediastinum caused by alveolar air leaks and resembled the vacuum phenomenon caused by intervertebral disc degeneration.

Chronic Eosinophilic Pneumonia: A Pediatric Case with Idiopathic Bronchiectasis.

Chronic eosinophilic pneumonia (CEP) is a rare lung disease and is especially uncommon in children. It presents with subacute respiratory symptoms of hypoxemia and dyspnea, peripheral infiltrates on imaging, and eosinophilia. However, it can be difficult to diagnose, as there is no strict diagnosis criteria and the clinical findings may be very nonspecific. In this case report, we describe a 14-year-old female with an unusual presentation of asymptomatic bronchiectasis, and the role of surgical lung biopsy in the diagnosis of CEP when no peripheral or alveolar eosinophilia is seen. It suggests that perhaps bronchiectasis can also be an unusual presenting sign of CEP and that there may be more asymptomatic cases of CEP with the true incidence being underreported, especially in the pediatric population.

A case of eosinophilic pneumonia simultaneously diagnosed in a patient and a tame cat: a case report

IntroductionChronic eosinophilic pneumonia is an idiopathic disorder of unknown etiology. Corticosteroid treatment provides a good response but recurrence frequently occurs after tapering of corticosteroid. Chronic eosinophilic pneumonia occurs predominantly in middle-aged women and non-cigarette smokers, which leads to the speculation that environmental antigens, particularly in the home, contribute to the etiology.Case presentationA 66-year-old Japanese woman was given a diagnosis of chronic eosinophilic pneumonia for 8 years and was treated with prednisone. She developed respiratory symptoms again with tapering of prednisone (10mg/day). A chest radiograph revealed patchy shadows in her bilateral upper lung fields, and bronchoalveolar lavage fluid revealed marked eosinophilia. Based on negative findings for other causes of eosinophilia, the diagnosis of the recurrence of chronic eosinophilic pneumonia was established. She was treated with prednisone (20mg/day), which demonstrated rapid improvement. Around the same time, her tame cat developed oral breathing, tachypnea and peripheral eosinophilia. Chest radiography of the cat revealed ground-glass opacity in its bilateral upper lung fields. Eosinophilic pneumonia was also diagnosed in the cat that was treated by prednisone (3mg/day). Since eosinophilic pneumonia was diagnosed simultaneously in the patient and her tame cat, it can be suggested that inhaled environmental antigens in the home caused the eosinophilic pneumonia. After moving out of her home, she and the cat had no recurrence of eosinophilic pneumonia.ConclusionsAlthough chronic eosinophilic pneumonia is an idiopathic disorder of unknown etiology, our case suggests that inhaled environmental antigens in the home may be associated with the causes of chronic eosinophilic pneumonia. A pet’s disease may give us an important clue for the therapeutic approach of the owner’s disease.

Case of invasive mucinous adenocarcinoma mimicking chronic eosinophilic pneumonia.

Invasive mucinous carcinoma is difficult to distinguish from other lung diseases; therefore, confirmation of the diagnosis may be delayed. A 64-year-old woman was admitted with a six-month history of cough, febrile sensation, and shortness of breath, with worsening symptoms. A computed tomography scan of the chest revealed bilateral homogenous ground-glass opacities and consolidation with subpleural predominance. The percentage of eosinophils in the serum and induced sputum was elevated and a diagnosis of chronic eosinophilic pneumonia was established. Despite administration of a systemic steroid, she did not rapidly respond. We performed a percutaneous needle biopsy and finally confirmed invasive mucinous adenocarcinoma.

Pulmonary Cavity due to Chronic Eosinophilic Pneumonia Associated with Arsenicosis

In developing country like India arsenic poisoning is a major public health problem. Association of chronic eosinophilic pneumonia and chronic diarrhea with arsenicosis is rare. Also pulmonary cavity formation in chronic eosinophilic pneumonia is very uncommon. A 44-year-old male patient, resident of an arsenic affected area was admitted for evaluation of chronic diarrhoea, persistent peripheral eosinophilia along with radiologically visible cavity in right upper zone. There were dermatological manifestations of arsenicosis along with presence of noncirrhotic portal fibrosis and peripheral eosinophilia. On bronchoalveolar lavage study, eosinophil comprised 40% of total cellularity making the diagnosis of chronic eosinophilic pneumonia. After ruling out all possible causes of diarrhoea and chronic eosinophilic pneumonia, we came to conclusion that arsenic could be implicated as causative agent.

Pneumonia eosinofílica crônica secundária ao uso prolongado de nitrofurantoína: achados da tomografia computadorizada de alta resolução do tórax

The authors report the case of a female patient who developed chronic eosinophilic pneumonia secondary to long-term use of nitrofurantoin for prophylaxis of recurrent urinary tract infections due to urethral stenosis. On high-resolution computed tomography scans, the pulmonary reaction to nitrofurantoin most commonly manifests as an interstitial-alveolar pattern in both lung bases. However, in this case, the alterations were most pronounced in the periphery of the upper lobes. In itself, this tomographic profile is strongly indicative of chronic eosinophilic pneumonia. The patient had previously been submitted to an open lung biopsy. The diagnosis of chronic eosinophilic pneumonia was confirmed through a review of the biopsy.

Fevers, Weight Loss, and Bilateral Peripheral Infiltrates in a Young Man

(CHEST 1999; 115:1181‐1183) A 28-year-old man with a remote history of snorting cocaine presented with a 3-month history of fevers, nightsweats, weight loss, and cough. Similar symptoms had occurred 1.5 years earlier. At that time, the appearance of the chest radiograph (Fig 1), borderline peripheral eosinophilia (total eosinophil count of 300/mm 3 ), and negative sputum and blood cultures prompted the diagnosis of chronic eosinophilic pneumonia (CEP). The symptoms and lung opacities markedly improved within 2 weeks of initiating prednisone treatment at 60 mg qd. Three months later, the patient stopped taking steroids and was lost to follow-up. He denied using illicit drugs between presentations. Physical Examination The patient’s temperature was 36.8°C, pulse was 84 beats/min, BP was 148/94, and respirations were 28 breaths/min. The patient was well-appearing and had a nonproductive cough. There were raised violaceous lesions on his left shoulder and forehead. The chest was clear, the heart had an increased P2 component, and there was a 1.5 3 1.5-cm right submandibular lymph node.

Clinical Investigation of 11 Cases of Chronic Eosinophilic Pneumonia Reported in Korea

Background: Chronic eosinophilic pneumonia(CEP) presents with profound systemic symptoms, including fever, malaise, night sweats, weight loss, and anorexia together with localized pulmonary manifestations such as cough, wheeze, and sputum. It is an illness occurring predominantly in women. The chest radiogragh shows fluffy opacities that often have a characteristic peripheral configuration. The hallmark of CEP is the peripheral blood eosinophilia and a prompt response to oral corticosteroid therapy. We investigated characteristics of eleven patients of chronic eosinophilic pneumonia, reported in Korea. Method: There were eleven reports of CEP from 1980 to 1996, including three cases experienced in our hospital. The journals were analysed in respects of clinical history, laboratory, and radiographic findings. Results: 1) Male vs. female ratio is 3 : 8. The peak incidence occurred in forty and fifty decades. The atopic diseases were present in 6 cases. Asthma was the commonest manifestation 2) The presenting symptoms were as follows: cough, dyspnea, sputum, weight loss, fever, general weakness, night sweats, urticaria with the descending incidence. 3) Peripheral blood eosinophilia was present in all patients(mean ; 38.4%) and serum IgE level was elevated in nine patients(mean ; 880IU/ml). Conclusion: The diagnosis of chronic eosinophilic pneumonia is based on classic symptoms, including fever, night sweats, weight loss with a typical roentgenogram of peripheral pulmonary infiltrates and peripheral blood eosinophilia, and that is confimed by lung biopsy and/or bronchoalveolar lavage. Chronic eosinophilic pneumonia is responsive to corticosteroid promptly and recommended at least 6 months of therapy to prevent relapse.

Diagnostic problems in chronic eosinophilic pneumonia.

To identify the problems involved in the diagnosis of chronic eosinophilic pneumonia (CEP), clinical findings were analysed for 43 patients diagnosed clinically or pathologically with CEP during the past 10 years. About 28% of patients showed peripheral blood eosinophilia and a typical pattern of pulmonary oedema on chest X-ray at initial examination. Eosinophilia was demonstrated in peripheral blood in 86% of patients, in bronchoalveolar lavage (BAL) in 100%, and in transbronchial lung biopsy (TBLB) specimens in 64% of patients. Peripheral blood tests, BAL, and TBLB were all positive for eosinophilia in 60% of patients. BAL was the single test most likely to be positive among the diagnostic tests used in the present study. When CEP is suspected clinically, an understanding of which site is examined by each of the diagnostic tests and of the likelihood of a positive result in each test will facilitate the selection of the most appropriate tests for individual patients.

Circulating immune complexes in chronic eosinophilic pneumonia.

In 9 out of 14 patients with chronic eosinophilic pneumonia (CEP), followed-up in our department, circulating immune complexes (CIC) and other immunologic indices were investigated. The diagnosis of CEP was based on the typical clinical and radiographic findings and on the demonstration of eosinophilia in serum, bronchoalveolar lavage (BAL), fiberoptic transbronchial biopsies and surgical lung biopsies. CIC measured by solid-phase monoclonal RF binding were always strongly positive during a flare-up of CEP, and CIC measured by solid-phase C1q binding were also positive in most cases. Remissions of CEP were accompanied by lowering or disappearance of CIC. CIC were significantly correlated with eosinophilia (p less than 0.001 for RF and p less than 0.02 for C1q). Other immunologic indices were normal except for increased IgE in two thirds of the patients, and a slightly positive rheumafactor without rheumatic disease in half of the patients. The CIC are thus related to disease activity, and can be used as one of the markers of it, in addition to the classical markers such as eosinophilia and chest X-ray. However, this does not imply that the CIC have a pathogenetic role in CEP; these CIC can, indeed, be an epiphenomenon only.

慢性好酸球性肺炎の診断における経気管支肺生検（ＴＢＬＢ）の有用性の検討

慢性好酸球性肺炎の診断における経気管支肺生検（ＴＢＬＢ）の有用性の検討

Chronic Eosinophilic Pneumonia (Carrington's) With Increased Serum IgE Levels

We report our second case of chronic eosinophilic pneumonia (CEP) (Carrington's pneumonia) with elevated serum IgE values and present a review of the literature on this subject. Our present patient, a 55-year-old woman, had classic symptoms of dry cough, weight loss, malaise, dyspnea, night sweats, and fevers. Significant peripheral blood eosinophilia and a right upper lobe infiltrate were present. Glucocorticoid therapy caused prompt resolution of symptoms, as well as disappearance of blood eosinophilia, elevated serum IgE levels, and pulmonary shadowing. The diagnosis of CEP should not be neglected in the classification of the eosinophilic pneumonias with increased serum IgE levels. The increased serum IgE levels, when present in CEP, seem nonspecific and thus may not be useful as a diagnostic adjunct. However, measurement of IgE may be helpful in CEP, as it has been in allergic bronchopulmonary aspergillosis, to guide the dosage and duration of corticosteroid therapy.

Acute respiratory failure accompanied with eosinophilia.

Chronic eosinophilic pneumonia is an idiopathic condition characterized by chronic infiltration of the lung with eosinophils, weight loss, dyspnea, and pulmonary infiltration. Recently, we have experienced one case of chronic eosinophilic pneumonia presenting as the acute respiratory failure. A 34-year-old man was admitted to the hospital with one month's history of coughing, dyspnea, mucoid sputum, weight loss and one day's history of subcutaneous emphysema. The radiographic lung lesion and dyspnea rapidly progressed to a critical condition of acute respiratory failure. The combination of blood eosinophilia, lung infiltration on the chest x-ray, sign of acute rapiratory failure, rapid response to steroid therapy, and the finding of the transbronchial lung biopsy permit the diagnosis of chronic eosinophilic pneumonia.