Eosinophilic Pneumonia Research Articles

Acute Eosinophilic Pneumonia Associated with E-Cigarettes: A Case Report

Acute Eosinophilic Pneumonia Associated with E-Cigarettes: A Case Report

Ulcerative colitis developed after remission of eosinophilic pneumonia.

Pediatrics InternationalAccepted Articles e15486 CLINICAL NOTE Ulcerative colitis developed after remission of eosinophilic pneumonia Motoko Yasutomi, Corresponding Author Motoko Yasutomi yasutomi@u-fukui.ac.jp orcid.org/0000-0003-1165-3632 Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan Correspondence Motoko Yasutomi, M.D., Ph.D., Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka Eiheiji-cho Yoshida-gun, Fukui 9101193, Japan, Email: yasutomi@u-fukui.ac.jpSearch for more papers by this authorSachiyo Nitta, Sachiyo Nitta Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, JapanSearch for more papers by this authorTaihei Hayashi, Taihei Hayashi Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, JapanSearch for more papers by this authorToshihide Yoshikawa, Toshihide Yoshikawa orcid.org/0000-0003-3999-9379 Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, JapanSearch for more papers by this authorTatsushi Naito, Tatsushi Naito Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, JapanSearch for more papers by this authorYusei Ohshima, Yusei Ohshima orcid.org/0000-0002-4488-0308 Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, JapanSearch for more papers by this author Motoko Yasutomi, Corresponding Author Motoko Yasutomi yasutomi@u-fukui.ac.jp orcid.org/0000-0003-1165-3632 Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan Correspondence Motoko Yasutomi, M.D., Ph.D., Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka Eiheiji-cho Yoshida-gun, Fukui 9101193, Japan, Email: yasutomi@u-fukui.ac.jpSearch for more papers by this authorSachiyo Nitta, Sachiyo Nitta Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, JapanSearch for more papers by this authorTaihei Hayashi, Taihei Hayashi Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, JapanSearch for more papers by this authorToshihide Yoshikawa, Toshihide Yoshikawa orcid.org/0000-0003-3999-9379 Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, JapanSearch for more papers by this authorTatsushi Naito, Tatsushi Naito Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, JapanSearch for more papers by this authorYusei Ohshima, Yusei Ohshima orcid.org/0000-0002-4488-0308 Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, JapanSearch for more papers by this author First published: 26 January 2023 https://doi.org/10.1111/ped.15486 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/ped.15486. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future.e15486 RelatedInformation

Aynı Evde Yaşayan Ve Astım Atak Tablosu İle Başvuran İki Olgu: Nedeni Eroin İnhalasyonu

Heroin inhalation can cause bronchospasm in the lungs, asthma exacerbation and acute eosinophilic pneumonia. Starting from a clinically mild picture, it can result in a clinical picture that is severe enough to require mechanical ventilation support. In this article, two cases who applied with asthma exacerbation after heroin inhalation will be presented and the literature will be reviewed.

Targeting IL-5/5R for the treatment of idiopathic chronic eosinophilic pneumonia

Targeting IL-5/5R for the treatment of idiopathic chronic eosinophilic pneumonia

Radiographic Distribution as a Diagnostic Clue in Pulmonary Disease.

Because some disease processes produce radiographic abnormalities that occur in characteristic distributions in the chest, classifying the position and appearance of these suggestive features and the underlying diseases provides a tool by which diagnostic accuracy might be improved. The goal of this review is to offer to the chest clinician a taxonomy of these disease entities that can produce characteristic chest radiographic distributions. These radiographic distributions often reflect anatomic or physiologic conditions that drive the radiographic appearance; for example, foramen of Morgagni diaphragmatic hernias most commonly present in the right ventral chest, consistent with the anatomic location of the diaphragmatic foramen. This taxonomy includes 3 distributional categories: (1) upper versus lower lung zone-predominant processes, (2) central versus peripheral processes, and (3) processes with distinctive focal locations, eg, "photonegative appearance" as in chronic eosinophilic pneumonia. It is hoped that this taxonomy aids the chest clinician in generating and streamlining a differential diagnosis and in ascertaining the specific cause of diseases with radiographic abnormalities.

621. Pharmacokinetics Determinant and Risk Factors of Daptomycin Induced Eosinophilic Pneumonia and Muscular Toxicity: A Survival Analysis in patients treated for Bone and Joint Infection.

Abstract Background Daptomycin prescription for patients suffering from Bone and Joint infections increased in recent years. However, the implication between daptomycin exposure, concomitant factor, and the occurrence of either daptomycin-induced eosinophilic pneumonia (DIEP) or CPK elevation is not clearly understood. Methods All patients treated for a bone and joint infection (BJI) between 2014 and 2021 were screened and classified into cases if they experienced a CPK elevation or DIEP. The controls were randomly selected at a 1:3 ratio within the same period of inclusion. Daptomycin levels were obtained from routine therapeutic drug monitoring. In addition, demographic and biology data were also obtained from the computerized file of patients. Those data were used to compute the area under the concentration-time curve (AUC) of daptomycin using a previously developed population pharmacokinetic model. Finally, a univariate analysis was performed and all data with a p-value < 0.1 were included in the multivariate survival analysis using a proportional Cox hazard model. Results A total of 1130 patients were screened from which 16 patients with DIEP, 42 with CPK elevation, and 107 control were included in the final analysis. Age, CRP, Creatinine, Creatinine Clearance, Serum protein, AUC, and through concentrations were significantly different between case and controls. Summary of univariate analysis is available in table 1. After multivariate analysis, only 3 predictors remained significantly associated with the occurrence of DIEP or CPK elevation. The adjusted hazard ratio of developing DIEP of CPK elevation, were 3.1 (95% CI: 1.48 – 6.5, p < 0.001) for a daptomycin AUC > 939 mg.h/L, 9.8 (95% CI 3.94 – 24.5, p < 0.001) for CRP > 21.6mg/L and 2.4 (95% CI 1.02 – 5.65, p = 0.04] for Protein < 72g/L. Survival curves are shown in figure1. Variable identified in the whole population remained significant in DIEP or CPK subgroup analyses. Table 1.Patients characteristics at time of inclusionFigure 1.Survival analysis of the whole population according to AUC and CRP levels. Conclusion The risk of experiencing DIEP or CPK elevation was greater in patients with an AUC0-24 above 939 mg.h/L and a CRP > 21.6mg/L. Daptomycin Therapeutic drug monitoring should be performed and an AUC range of 666 to 939 mg.h/L should be targeted in order to maximize efficacy and minimize the risk of adverse events, especially for patients with an inflammatory syndrome. Disclosures All Authors: No reported disclosures.

Smoking-related interstitial lung disease

Exposure to smoke is associated with the development of diseases of the airways and lung parenchyma. Apart from chronic obstructive pulmonary disease (COPD), in some individuals, tobacco smoke can also trigger mechanisms of interstitial damage that result in various pathological changes and pulmonary fibrosis. A causal relation has been established between tobacco smoke and a group of entities that includes respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), desquamative interstitial pneumonia (DIP), Langerhans cell histiocytosis (LCH), and acute eosinophilic pneumonia (AEP). Smoking is considered a risk factor for idiopathic pulmonary fibrosis (IPF); however, the role and impact of smoking in the development of this differentiated clinical entity, which has also been called combined pulmonary fibrosis and emphysema (CPFE) as well as nonspecific interstitial pneumonia (NIP), remains to be determined. The definition of smoking-related interstitial fibrosis (SRIF) is relatively recent, with differentiated histological characteristics. The likely interconnection between the mechanisms involved in inflammation and pulmonary fibrosis in all these processes often results in an overlapping of clinical, radiological, and histological features in the same patient that can sometimes lead to radiological patterns of interstitial lung disease that are impossible to classify. For this reason, a combined approach to diagnosis is recommendable. This combined approach should be based on the joint interpretation of the histological and radiological findings while taking the clinical context into consideration. This paper aims to describe the high-resolution computed tomography (HRCT) findings in this group of disease entities in correlation with the clinical manifestations and histological changes underlying the radiological pattern.

Challenges in managing a multifactorial eosinophilic pneumonia: daptomycin vs strongyloidiasis case report

BackgroundEosinophilia is defined as a blood eosinophil count > 500/mcL with etiology usually an allergic reaction or parasitic infection which can lead to serious organ damage.Case presentationA patient being treated for hardware infection develops eosinophilia while on daptomycin in the setting of a positive strongyloides antibody. The patient was on chronic steroids prior to admission for epitheliopathy which complicated care. The daptomycin was discontinued, ivermectin initiated to treat strongyloidiasis, and high dose steroids initiated simultaneously. Eosinophilia resolved and patient discharged home after two months in the hospital.ConclusionMultifactorial eosinophilia poses question of steroid harm in the setting of parasitic infection. Patient was treated for both strongyloides and daptomycin induced eosinophilia with improvement and discharge from the hospital.

Enfermedades pulmonares intersticiales relacionadas con el tabaco

Exposure to smoke is associated with the development of diseases of the airways and lung parenchyma. Apart from chronic obstructive pulmonary disease (COPD), in some individuals, tobacco smoke can also trigger mechanisms of interstitial damage that result in various pathological changes and pulmonary fibrosis. A causal relation has been established between tobacco smoke and a group of entities that includes respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), desquamative interstitial pneumonia (DIP), Langerhans cell histiocytosis (LCH), and acute eosinophilic pneumonia (AEP). Smoking is considered a risk factor for idiopathic pulmonary fibrosis (IPF); however, the role and impact of smoking in the development of this differentiated clinical entity, which has also been called combined pulmonary fibrosis and emphysema (CPFE) as well as nonspecific interstitial pneumonia (NIP), remains to be determined. The definition of smoking-related interstitial fibrosis (SRIF) is relatively recent, with differentiated histological characteristics. The likely interconnection between the mechanisms involved in inflammation and pulmonary fibrosis in all these processes often results in an overlapping of clinical, radiological, and histological features in the same patient that can sometimes lead to radiological patterns of interstitial lung disease that are impossible to classify. For this reason, a combined approach to diagnosis is recommendable. This combined approach should be based on the joint interpretation of the histological and radiological findings while taking the clinical context into consideration. This paper aims to describe the high-resolution computed tomography (HRCT) findings in this group of disease entities in correlation with the clinical manifestations and histological changes underlying the radiological pattern.

Seventeen Cases of Daptomycin-Induced Eosinophilic Pneumonia in a Cohort of Patients Treated for Bone and Joint Infections: Proposal for a New Algorithm.

Daptomycin is increasingly used in the treatment of bone and joint infections (BJIs) and may be responsible for daptomycin-induced eosinophilic pneumonia (DIEP), a potentially severe adverse drug reaction. The aim of this study was to describe DIEP in patients treated at a referral center for the management of BJI, and to revisit current definitions of this disease. Patients treated from 1 January 2012 to 31 March 2021 were included in a prospective cohort (NCT02817711), in which all potential serious adverse events are prospectively recorded. Patients diagnosed with DIEP were retrospectively analyzed using different definitions. In a total of 4664 patients included in the cohort during the study period, 1021 patients (21.9%) received daptomycin, of whom 17 (1.7%) were diagnosed with DIEP. Most patients were male (n = 11 [64.7%]), and periprosthetic joint infection was the commonest BJI (n = 12 [70.6%]). Only 1 patient had bronchoalveolar lavage (BAL) eosinophil count ≥25%, while most patients had peripheral blood eosinophilia (n = 15 [88.2%]). Chest computed tomography (CT) was compatible with eosinophilic pneumonia in 13 of 14 cases (92.9%). All patients recovered upon discontinuation of daptomycin. Using the different definitions available, only a minority of cases fulfilled existing criteria for DIEP. We propose a new algorithm that includes specific CT scan signs, and systemic instead of BAL eosinophilia. DIEP is a rare event that requires prompt discontinuation of the causative antibiotic. Current criteria to diagnose definite DIEP are too restrictive and not easily applicable in clinical practice. A new algorithm is proposed here (Lyon algorithm) to facilitate the early identification of DIEP.

Predictive factors for relapse in corticosteroid-treated patients with chronic eosinophilic pneumonia.

Chronic eosinophilic pneumonia (CEP) is an idiopathic disorder characterised by an abnormal and marked accumulation of eosinophils in the interstitium and alveolar spaces of the lungs. Systemic corticosteroid (CS) therapy leads to marked improvement. However, relapse is common in the clinical course, and the predictive factors for relapse of CEP are not well known. This study aimed to investigate predictive factors for relapse in CS-treated cases of CEP. We identified consecutive patients with CEP at our institution between 1999 and 2019. We retrospectively reviewed 36 CS-treated patients with CEP who underwent bronchoalveolar lavage (BAL) and high-resolution computed tomography (CT) at diagnosis. We examined relapse at least 1 year after the initiation of CS treatment. Statistical analysis included univariate and multivariate Cox proportional hazard regression analyses; P<0.05 was considered statistically significant. The median (interquartile range) age at diagnosis was 59.5 years (47.8-70.0 years). This study included 13 men and 23 women. Twenty-five patients (69.4%) were never smokers and 15 (41.7%) had asthma. The peripheral blood eosinophil percentage was 35.0% (15.6-55.8%), and the BAL eosinophil percentage was 40.8% (10.7-68.5%). The median serum surfactant protein-D (SP-D) level was 135 ng/mL (82.2-176.7 ng/mL). High-resolution CT revealed centrilobular opacities in 23 patients (63.9%). Relapse of CEP was observed in 20 patients (55.6%). Higher serum SP-D levels and the presence of centrilobular opacities on high-resolution CT were significant predictors of relapse in multivariate Cox proportional hazard regression analysis (P=0.017 and P=0.028, respectively). Additionally, we devised a relapse prediction model for CS-treated CEP using two categorical parameters: the presence of centrilobular opacities and serum levels of SP-D (>135/≤135 ng/mL). Based on these parameters, cases were scored 2, 1, or 0. Patients with a score of 2 experienced relapses earlier than those with scores of 1 and 0 (log-rank test; P=0.006, P=0.003, respectively). Centrilobular opacities on high-resolution CT and higher serum SP-D levels at diagnosis may be predictive factors for relapse in CS-treated patients with CEP.

CASE OF CHRONIC EOSINOPHILIC PNEUMONIA IN A PREGNANT PATIENT

<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.

A confluence of advanced treatment options for atopic dermatitis, eosinophilic lung diseases and chronic urticaria brought about by the revolutionary discovery of biologics and Janus kinase inhibitors.

A confluence of advanced treatment options for atopic dermatitis, eosinophilic lung diseases and chronic urticaria brought about by the revolutionary discovery of biologics and Janus kinase inhibitors.

UNUSUAL PRESENTATION OF HETEROZYGOUS RAG1 DEFICIENCY

<h3>Introduction</h3> RAG1 mutations are associated with a broad range of clinical and immunologic phenotypes. We present an adolescent with heterozygous RAG1 mutation identified during work-up for immune dysregulation. <h3>Case Description</h3> A 17-year-old female with a history of sinusitis presents with recurrent episodes of acute hypoxic respiratory failure. Respiratory failure was responsive to oral corticosteroids (OCS). Diagnostic findings were notable for peripheral eosinophilia (AEC of 1,000), ground glass opacities on chest CT, and bronchoscopy with a BAL of 10% eosinophils without evidence of granulomas or vasculitis. Rheumatologic work-up was unrevealing. A unifying diagnosis was not determined but was presumed to be eosinophilic asthma versus chronic eosinophilic pneumonia. Mepolizumab was initiated with significant improvement. Less than two months later, she was admitted for autoimmune hemolytic anemia and immune thrombocytopenia (Evan's Syndrome). Initially unresponsive to OCS, Rituximab proved to be a successful therapy. Immune work-up revealed low IgG, normal IgA, IgM, and IgE, within normal limits T/B/NK cells with slightly decreased CD3+ and CD19+ cells, elevated unswitched memory B cells, protective tetanus and strep pneumonia titers, and normal mitogen proliferation. Genetic testing revealed a heterozygous <i>RAG1</i> mutation (c.2210G>A(p.Arg737His)) associated with severe combined immunodeficiency. The same genetic variant was found in her asymptomatic mother. RAG1 functional testing is pending. <h3>Discussion</h3> Unlike homozygous RAG1 mutations, heterozygous patients have less severe immunodeficiency and can present with autoimmunity. Eosinophilia has been noted in some presentations. This case highlights how genetic testing can be utilized in the work-up and diagnosis of patients presenting with immune dysregulation.

The Accuracy 0f CT Chest in Determining Between Ground Glass Opacities And Those Caused by Covid-19 And Other Medications

Introduction: Diagnostic ct scanning of the chest is currently being investigated for its ability to distinguish between ground glass opacities (GGO) caused by coronavirus 2019 (COVID-19) and GGO produced by other causes. Place and Duration: From January 2022 until June 2022, I will work as a Radiologist at Qazi Hussain Ahmad Hospital in Nowshera. Methods: This study was cross sectional study carried out at the Qazi Hussain Ahmad Hospital, Nowshera for a period of six months. The overall sample size in the current study was100 non-contrast chest CTs. Eexperienced radiologists analyzed the CT images of the chest after redacting any personal information. laboratory results and the patient's medical history were noted. Results: The participants comprised 46 people with COVID19 and 100 without COVID19 who also had ground glass opacities on chest CT. There was no statistically significant difference in age between the groups (p-value = 0.212). Out of the non-COVID-19 GGO cases, three patients have hypersensitivity pneumonia in 3, eosinophilic pneumonia in 3, interstitial pneumonia in 7, pulmonary pneumonia in 3, pulmonary fibrosis in 7, drug-induced lung damage in 7, pulmonary alveolar hemorrhage in 3, and pulmonary emphysema in 11. Practical implication: This study will provide physician with the data to compare the likelihood that COVID-19 causes ground glass opacities on a chest CT scan versus the likelihood that they are caused by other probable causes Conclusion: Moreover, the specificity of chest CT in differentiating COVID-19 from viral pneumonia is only intermediate, and the specificity of chest CT in distinguishing COVID-19 from other reasons of ground glass opacities is poor. Keywords: CT Chest, Determining, Ground-Glass Opacities, Covid-19, Medications

Oil Red O Staining of Pulmonary Macrophages in Bronchoalveolar Lavage Specimens Is Not Specific for Vaping-Associated Lung Injury.

Oil Red O (ORO) positivity in bronchoalveolar lavage (BAL) fluid macrophages in the setting of e-cigarette, or vaping, product use-associated acute lung injury (EVALI) has been frequently requested by clinicians based on rare reports and subsequent US Centers for Disease Control and Prevention guidelines. The aim of this study was to determine the specificity of ORO staining in BAL specimens with disease states other than EVALI. Consecutive BAL specimens (October-December 2019) were stained with ORO. The lipid-laden macrophage index (LLMI) was calculated for each case. We studied BAL samples from 50 patients. Indications for BAL were surveillance bronchoscopy for lung transplantation (27/50), suspected infection (12/50), sarcoidosis/suspected sarcoidosis (3/50), nodules or ground-glass opacities (3/50), hemoptysis (2/50), asthma or eosinophilic pneumonia (2/50), and idiopathic pulmonary fibrosis (1/50). ORO staining was seen in BAL fluid macrophages in 45 of 50 cases (focal in 18, moderate in 23, diffuse in 4); LLMI ranged from 0 to 218. Using a threshold of LLMI of 85 or higher as positive, ORO was positive in 7 of 50 (14%) cases (range, 85-218). ORO staining in BAL fluid macrophages is not specific for EVALI. Even when an LLMI of 85 or higher is used as a threshold for positivity, ORO positivity occurs in a significant subset of non-vaping-related cases.

BLUE FINGERS, EOSINOPHILIC LUNGS: ACUTE EOSINOPHILIC PNEUMONIA FOLLOWING COVID-19 INFECTION

BLUE FINGERS, EOSINOPHILIC LUNGS: ACUTE EOSINOPHILIC PNEUMONIA FOLLOWING COVID-19 INFECTION

LYMPHANGITIC CARCINOMATOSIS PRESENTING AS CHRONIC EOSINOPHILIC PNEUMONIA

LYMPHANGITIC CARCINOMATOSIS PRESENTING AS CHRONIC EOSINOPHILIC PNEUMONIA

DAPTOMYCIN-INDUCED EOSINOPHILIC PNEUMONITIS

DAPTOMYCIN-INDUCED EOSINOPHILIC PNEUMONITIS

A CASE OF MYCOBACTERIUM AVIUM COMPLEX PULMONARY INFECTION WITH SEVERE EOSINOPHILIA TREATED WITH MEPOLIZUMAB

A CASE OF MYCOBACTERIUM AVIUM COMPLEX PULMONARY INFECTION WITH SEVERE EOSINOPHILIA TREATED WITH MEPOLIZUMAB