AB003. Eosinophilic pneumonia: an interesting case report

Abstract: A previously healthy, 24-year-old man is admitted to the hospital because of nonproductive cough and bilateral diffuse pulmonary infiltrations on chest radiograph. Physical examination findings are normal. Vital signs: SpO₂: 92%, 95 bpm, BP: 120/90 mmHg, temperature: 36.5 °C, ECG: SR. Laboratory values: WBC =19,000 (67.6% PMN, 8.6% LY, 18.7% EOS), ESR =18, CRP =13.3, ANCA-P (−), ANC-C (−), IgE =256, HIV (−), HbsAg (−), stool parasitology analysis (−). His Chest CT shows multiple diffuse infiltrations with multiple nodular opacities of centrolobular localisation in all pulmonary segments and no enlarged lymph nodes in the mediastinum and hilum. Bronchoscopy: no abnormal endoscopic findings. BAL was performed in the middle lobe. The cytology of BAL fluid showed a few glandular cellular gatherings with benign characters, macrophages (40%), few lymphocytes (5%) and numerous eosinophils (55%). No findings of malignancy were founded. Direct ZIEHL-NEELSEN was negative. Initially the patient was treated with oseltamivir 75 mg S: 1×2, moxifloxacin 500 mg S: 1×1. After BAL results, the diagnosis of eosinophilic pneumonia was made and methylprednisolone 40 mg IV was added in the treatment. On the fifth day of hospitalization, dramatic improvement of radiographic findings was observed. Furthermore, the patient’s inflammatory markers improved (decrease of WBC & CRP). L/V and chest CT were repeated on the 8th day of hospitalization. A decrease of eosinophils count (9.2%) was observed and lung infiltrations receded. Eosinophilic pneumonias are a group of diseases characterized by the presence of eosinophilic infiltrations in the pulmonary parenchyma, and a high count of eosinophils in bronchoalveolar lavage (BAL)—with or without the presence of peripheral eosinophilia. Parasites are the most common cause in developing countries. In developed countries, eosinophilic lung diseases are uncommon and usually idiopathic. They are classified into two major groups. Those diseases of unknown cause (idiopathic or endogenous) belong to the first group while those which can be linked with various known factors (secondary or exogenous) belong to the second group. The diagnosis is made by taking a thorough medical history, carrying out various laboratory tests and is confirmed by lung biopsy. Corticosteroids are often required for the treatment of eosinophilic lung diseases and are the medication of choice.

Keywords: Peripheral eosinophilia; pneumonia; eosinophilic infiltrations