ABSTRACT
A 69-year-old female patient visited the emergency room with fever (38.3degrees C) and dyspnea. She had been taking prednisolone (5 mg once per day) and methotrexate (2.5 mg once per week) for rheumatoid arthritis for 2 years. Chest computed tomography (CT) showed bilateral, multifocal ground glass opacity with interlobular septal thickening. Peripheral blood leukocyte count was 6,520/mm3 (neutrophils, 77.4%; eosinophils, 12.1%). During the night, mechanical ventilation was initiated due to the development of severe hypoxemia. Bronchoalveolar lavage fluid showed a high proportion of eosinophils (49%). Her symptoms improved dramatically after commencement of intravenous methylprednisolone therapy. This is the first report of idiopathic acute eosinophilic pneumonia developing in a current user of systemic corticosteroids.
Subject(s)
Female , Humans , Adrenal Cortex Hormones , Hypoxia , Arthritis, Rheumatoid , Bronchoalveolar Lavage Fluid , Dyspnea , Emergencies , Eosinophils , Fever , Glass , Leukocyte Count , Methotrexate , Methylprednisolone , Prednisolone , Pulmonary Eosinophilia , Respiration, Artificial , Respiratory Insufficiency , ThoraxABSTRACT
The mechanism and cause of acute eosinophilic pneumonia are largely unknown. Many factors including the smoking of cigarettes have been suggested, but none have been proven to directly cause acute eosinophilic pneumonia. The authors report a case of acute eosinophilic pneumonia in a young Asian male who recently started smoking. The diagnosis was made based on his clinical course and results of chest radiography, lung spirometry, bronchoalveolar lavage, and transbronchial lung biopsies. After administration of methylprednisolone, his clinical course rapidly improved. A provocation test was designed to establish a connection between cigarette smoking and the development of acute eosinophilic pneumonia. After the provocation test, the patient showed identical symptoms, increase in sputum eosinophils, and worsening of pulmonary function. The results of the provocation test suggest that smoking may directly cause acute eosinophilic pneumonia, and support previous reports of cigarette smoking-induced acute eosinophilic pneumonia.
Subject(s)
Adolescent , Humans , Male , Acute Disease , Bronchial Provocation Tests , Pulmonary Eosinophilia/etiology , Smoking/adverse effectsABSTRACT
Acute eosinophilic pneumonia (AEP) has been described as an idiopathic febrile illness with a duration of less than seven days with severe hypoxemia, pulmonary infiltrates, and no history of asthma. It has been reported that AEP is associated with smoking. Although the pathogenesis of smoking induced AEP is being actively studied, there is no direct histological evidence that smoking actually induces AEP. Recently, we encountered a case of AEP that may have been caused by smoking. We performed a cigarette smoking challenge test to verify that smoking was indeed the cause of AEP in this patient. Smoking induced an increase the proportion of eosinophils in the bronchoalveolar lavage fluid without any respiratory symptoms or abnormal radiological findings. This result suggests that smoking was the cause of AEP in this patient.
Subject(s)
Humans , Hypoxia , Asthma , Bronchoalveolar Lavage Fluid , Eosinophils , Pulmonary Eosinophilia , Smoke , SmokingABSTRACT
Acute eosinophilic pneumonia is reported as a specific disease entity. But, it is different from chronic eosinophilic pneumonia in its onset, clinical course and recurrence. Badesh et al reported the following diagnostic criteria os acute eosinophilic pneumonia a less than one-month history of symptoms prior to diagnosis, no evidence of asthma, the absence of other organic disease, no obvious etiology and an evidence of recurrent disease. We experienced a case of acute eosinophilic pneumonia in 37 old male. Pathologically eosinophilic pneumonia is confirmed and other features meet Badesh's criteria.
Subject(s)
Humans , Male , Asthma , Diagnosis , Eosinophils , Pulmonary Eosinophilia , RecurrenceABSTRACT
Most cases of eosinophilic pneumonia reported previously have followed a chronic course. The case presented here was acute in onset, suggesting a acute eosinophilic pneumonia. A model of criteria for acute and chronic eosinophilic pneumonia was made by Umeki in 1992. A previously healthy young man presented with cough, sputum, fever, and multiple small nodules on the chest radiograph. We confirmed eosinophilic pneumonia with bronchoalveolar lavage analysis and transbronchial lung biopsy. This case examplifies the recently descrived acute eosinophilic pneumonia.