ABSTRACT
We describe a 48-year-old man with family history of rheumatoid arthritis (RA) affected by chronic eosinophilic pneumonia (CEP) with severe peripheral eosinophilia. CEP might develop as a complication of longstanding active RA. The patient with 5 months history of seropositive RA and chronic respiratory symptoms, alveolar and blood eosinophilia, peripheral pulmonary infiltrates and pleural effusion on chest imaging. The lung may be involved as an extraarticular manifestation of RA. However, CEP is not recognized as a typical lung manifestation of RA, and the two diseases rarely coexist. The effusion was an eosinophil predominant exudates and was characterized by low pH, and glucose level and high lactic dehydrogenase. The patient responded rapidly to combination of steroids and disease modifying anti-rheumatic drugs.
Subject(s)
Humans , Middle Aged , Antirheumatic Agents , Arthritis, Rheumatoid , Eosinophilia , Eosinophils , Exudates and Transudates , Glucose , Hydrogen-Ion Concentration , Lung , Oxidoreductases , Pleural Effusion , Pulmonary Eosinophilia , Steroids , ThoraxABSTRACT
Anti-IgE therapy, using recombinant humanized anti-IgE antibodies, is clinically effective in patients with eosinophil-related disorders such as allergic asthma, allergic rhinitis, and chronic urticaria. Chronic eosinophilic pneumonia tends to respond promptly to systemic corticosteroid therapy, however; relapses are common following corticosteroid tapering. We treated two patients (17- and 19-yr-old males) of chronic eosinophilic pneumonia whose symptoms were cough and dyspnea on exertion. The symptoms were recurrent while tapering off corticosteroid. They were treated with anti-IgE antibody without recurrence for 2 yr and 15 months. Here, we first describe clinical experience of the 2 cases of chronic eosinophilic pneumonia.
Subject(s)
Adolescent , Humans , Male , Young Adult , Adrenal Cortex Hormones/therapeutic use , Antibodies, Anti-Idiotypic/therapeutic use , Cough/etiology , Dyspnea/etiology , Pulmonary Eosinophilia/diagnosis , Tomography, X-Ray ComputedABSTRACT
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 Ig E 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.
Subject(s)
Female , Humans , Male , Anorexia , Asthma , Biopsy , Bronchoalveolar Lavage , Cough , Diagnosis , Dyspnea , Eosinophilia , Eosinophils , Fever , Incidence , Korea , Lung , Pulmonary Eosinophilia , Recurrence , Sputum , Sweat , Thorax , Urticaria , Weight LossABSTRACT
Chronic eosinophilic pneumonia is characterized by multiple and dense areas of consolidation on chest radiographs and computed tomographic scans, persistent symptoms, a requirement for steroid therapy and possible relapses. The finding of increased BAL eosinophils is most helpful in diagnosis of patients presenting with chronic eosinophilic pneumonia. Therefore, although biopsy remains the gold standard for diagnosis of chronic eosinophilic pneumonia, it is usually not required if the clinical findings are characteristic and if the response to a trial of corticosteroids is rapid and complete. The male patient, aged 40years, presented with cough, chest pain, weight loss and peripheral infiltration of right middle lobe on the chest radiograph and chest computed tomographic scans. We confirmed chronic eosinophilic pneumonia with bronchoalveolar lavage analysis and transbronchial lung biopsy. We herein report a lobal type of chronic eosinophilic pneumonia with a brief review of literature.