AN UNUSUAL CASE OF COVID-19 COMPLICATED BY POSSIBLE ACUTE EOSINOPHILIC PNEUMONIA

ABSTRACT

SESSION TITLE COVID-19 Case Report Posters 1 SESSION TYPE Case Report Posters PRESENTED ON 10/17/2022 1215 pm - 0115 pm INTRODUCTION: Acute eosinophilic pneumonia (AEP) is a rare cause of acute respiratory failure. AEP has been reported in association with smoking, drugs, and infections. Very few reports of AEP accompanied by Coronavirus disease 2019 (COVID-19) exist in current literature. Here we describe a case of AEP in association with COVID-19. CASE PRESENTATION A 58-year-old female, non-smoker, with no medical history presented to the emergency room with fever, cough, and shortness of breath for 10 days. She received two doses of vaccine against COVID-19. Her vital signs were notable for oxygen saturation of 56% on room air and respiratory rate of 35 breaths per minute. Her physical exam was notable for distress, tachypnea, and diffuse rhonchi on lung auscultation. Her chest x-ray showed multifocal bilateral peripheral and basilar airspace opacities. A respiratory pathogen panel detected SARS-CoV-2. She was admitted to the medical intensive care unit and suffered worsening acute hypoxemic respiratory failure requiring intubation. She was treated with dexamethasone 6mg for a 10-day course with gradually decreasing oxygen requirements, and she underwent tracheostomy on hospital day 11. Despite this, she continued to deteriorate clinically. Review of laboratory results showed significant eosinophilia of 15.6% on her complete blood count upon withdrawal of steroids. A CTA scan of the chest showed no evidence of pulmonary embolic disease and demonstrated bilateral extensive dense consolidations. A diagnosis of acute eosinophilic pneumonia was suspected. Fungal cultures and stool ova and parasites were negative. She was started on methylprednisolone 1mg/kg and a bronchoscopy was performed with bronchioalveolar lavage (BAL) samples showing 4% eosinophils despite high dose steroid therapy. She was continued on high dose steroids with rapid improvement in her oxygen requirements. DISCUSSION: AEP is an acute febrile illness that can lead to acute respiratory failure. The presence of dense infiltrates in the early stages of COVID-19 and elevated inflammatory markers and reticence to perform bronchoscopy can delay making a diagnosis of AEP in a patient diagnosed with COVID19. The diagnostic hallmark of AEP is the detection of > 25% eosinophils in BAL samples. While this patient did not meet that criterion, she received high dose corticosteroids which may have suppressed pulmonary eosinophilia. A high index of suspicion for AEP should be maintained in patients with COVID-19 with evidence of eosinophilia and clinical deterioration, given that AEP improves rapidly with the appropriate treatment. CONCLUSIONS: AEP is an uncommon cause of respiratory failure that should be considered in patients with unexplained worsening respiratory status and evidence of eosinophilia. Bronchoscopy with bronchoalveolar lavage should be considered early, even in the setting of COVID-19 in patients without risk factors who develop severe disease. Reference #1 De Giacomi F, Vassallo R, Yi ES, Ryu JH. Acute Eosinophilic Pneumonia. Causes, Diagnosis, and Management. Am J Respir Crit Care Med. 2018;197(6)728-736. doi10.1164/rccm.201710-1967CI Reference #2 Murao K, Saito A, Kuronuma K, Fujiya Y, Takahashi S, Chiba H. Acute eosinophilic pneumonia accompanied with COVID-19 a case report. Respirol Case Rep. 2020;8(9) e00683. Published 2020 Nov 16. doi10.1002/rcr2.683 DISCLOSURES No relevant relationships by Hadya Elshakh No relevant relationships by Christina Jee Ah Rhee no disclosure on file for Lourdes Sanso;