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Original Research |

Acute eosinophilic pneumonia: correlation of clinical characteristics with underlying cause

Federica De Giacomi, M.D; Paul A. Decker, M.S; Robert Vassallo, M.D; Jay H. Ryu, M.D
Author and Funding Information

Funding: None

Prior abstract publication/presentation: None

Conflicts of Interest: RV has received grant funding support from Pfizer and the Flight Attendant Medical Research Institute. All others declare no conflicts of interest.

1Dipartimento Cardio-Toraco-Vascolare, University of Milan-Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza; via Pergolesi 33, 20900, Monza, Italy

2Health Sciences Research, Mayo Clinic, Rochester MN

3Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN

Address all correspondences to: Jay H. Ryu, MD, Division of Pulmonary and Critical Care Medicine, Gonda 18 South, Mayo Clinic, 200 First St. SW, Rochester, MN 55905.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.03.001
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Abstract

Background  Acute eosinophilic pneumonia (AEP) is an uncommon disease, often indistinguishable from acute respiratory distress syndrome or community-acquired pneumonia at initial presentation. AEP can be idiopathic but identifiable causes include medications and inhalational exposures including cigarette smoke.

Methods  Using a computer-assisted search, we retrospectively identified and reviewed the medical records of all patients diagnosed with AEP between January 1, 1998 and June 30, 2016 at our institution. We extracted demographic and clinical data including exposures (occupational, environmental, recreational, pharmacologic and smoking), laboratory and radiological findings, treatments, hospitalization including intensive care unit stay, and subsequent clinical course.

Results  Among 36 consecutive patients with AEP, 11 were smoking-related, 6 medication-related, and 19 idiopathic. Smoking-related AEP included 6 first-time smokers and 5 ex-smokers who had resumed smoking after a period of abstinence. Patients with smoking-related AEP were younger compared to both medication-related and idiopathic AEP (median age 22 vs. 47.5 vs. 55 years, respectively, p=0.004). Smoking-related AEP was less likely to be associated with peripheral eosinophilia at presentation (36% vs. 50% vs. 58%, p=0.52) but more likely to be hospitalized (100% vs. 50% vs. 63%, p=0.039), including a longer intensive care unit stay, when compared to medication-related and idiopathic cases.

Conclusion  AEP is associated with a good prognosis when recognized and treated promptly. In comparison to medication-related and idiopathic AEP, smoking-related AEP was less likely to be associated with peripheral eosinophilia at presentation but was characterized by more severe disease manifestations.


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