0
Communications to the Editor |

A Case of Cigarette Smoking-Induced Acute Eosinophilic Pneumonia Showing Tolerance FREE TO VIEW

Masamitsu Nakajima, MD, FCCP; Toshiaki Manabe, MD; Yoshihito Niki, MD, FCCP; Toshiharu Matsushima, MD, FCCP; Sasaki Takashi, MD
Author and Funding Information

Kawasaki Medical School Kurashiki, Japan Miyazaki Medical College Miyazaki, Japan

Correspondence to: Masamitsu Nakajima, MD, FCCP, Division of Respiratory Diseases, Department of Medicine and Pathology, Kawakaki Medical School, 577 Matsushima, Kurashiki, Japan 701-0192



Chest. 2000;118(5):1517-1518. doi:10.1378/chest.118.5.1517
Text Size: A A A
Published online

To the Editor:

We read the report of Shintani et al (January 2000). 1The authors reported a similar case in Internal Medicine.2 Therein, they cited our case report of cigarette smoke-induced eosinophilic pneumonia (CS-AEP), which appeared in abstract form in the Japanese Journal of Thoracic Diseases (Nippon Kyobu Shikkan Gakkai Zasshi) in 1997.3 Because there seems to be a misunderstanding related to our report in their discussion, we would like to clarify the following facts. Shintani et al1 stated that no fever, significant chest radiologic changes, or abnormal inflammatory data, such as those of C-reactive protein (CRP) or WBC counts, were observed in our case. However, our patient indeed manifested high fever (39°C) and severe dyspnea and exhibited abnormalties in WBC count, Pao2, and pulmonary function test results after a provocation test with cigarette smoke (three cigarettes). These facts were detailed and clearly described in Radiology in 1998.,4 Fifteen hours after the provocation test, the WBC count abruptly increased from 5.7μ L to 9.6 μL ×103 μL; Pao2 decreased from 93 to 56 mm Hg; diffusing capacity of the lung for carbon monoxide decreased from 97 to 59%; and FEV1 decreased from 83 to 61% (Fig 1 ).,3 We had to stop the provocation test at this point, because the provocation test induced obvious signs, symptoms, and laboratory abnormalities of pulmonary function, and the possiblity of serious complications was a major concern. After steroid treatment with methylprednisolone, these abnormal levels quickly returned to normal. Seriously abnormal serum data or the appearance of severely abnormal shadows on chest radiograph are not necessary to prove the connection of cigarette smoke to acute eosinophilic pneumonia (AEP). It should be realized that some patients with CS-AEP may experience severe respiratory failure and that a provocation test may culminate in a second episode of respiratory failure or even death.

Furthermore, the possibility of tolerance was also discussed by us in 1999.5 The article by Shintani et al2 was not the first to describe tolerance in CS-AEP. Therefore, we believe that their description of our case was inaccurate and that their literature search was insufficient.

We agree with them regarding the issue they raised on the importance of establishing a patient history. History of cigarette smoking should be sought in patients with AEP, particularly in young ones. It should be described in any case report, not only of patients with AEP, but also of any other patients with respiratory symptoms. In CS-AEP, it is especially important to know when the patient started smoking.

Figure Jump LinkFigure 1. Graphs of data obtained during a challenge test. Top, WBC and eosinophil count (in count× 103/μL) vs time. Middle, Pao2 and Paco2. Bottom, diffusion capacity of lung for carbon monoxide (Dlco) and FEV1 as percent of FVC vs time. m-PSL = methylprednisolone sodium succinate.Grahic Jump Location

References

Shintani, H, Fujimura, M, Ishiura,, et al (2000) A cause of cigarette smoking-induced acute eosinophilic pneumonia showing tolerance.Chest117,277-279. [CrossRef] [PubMed]
 
Shintan, H, Fujimura, M, Yasu, M, et al Acute eosinophilic pneumonia caused by cigarette smoking.Intern Med2000;39,66-68. [CrossRef] [PubMed]
 
Sasaki, T, Nakajima, M, Kawabata, S, et al Acute eosinophilic pneumonia induced by cigarette smoke [English abstract].Nihon Kyobu Shikkan Gakkai Zasshi1997;35,89-94. [PubMed]
 
Nakajima, M, Manabe, T, Niki, Y, et al Cigarette smoke-induced acute eosinophilic pneumonia.Radiology1998;207,829-831. [PubMed]
 
Nakajima, M, Yoshida, K, Miyashita, N, et al Eosinophilia and cough induced by resumption of cigarette smoking in a beginning smoker recovering from acute respiratory failure [English abstract].Nihon Kokyuki Gakkai Zasshi1999;37,543-548. [PubMed]
 

Figures

Figure Jump LinkFigure 1. Graphs of data obtained during a challenge test. Top, WBC and eosinophil count (in count× 103/μL) vs time. Middle, Pao2 and Paco2. Bottom, diffusion capacity of lung for carbon monoxide (Dlco) and FEV1 as percent of FVC vs time. m-PSL = methylprednisolone sodium succinate.Grahic Jump Location

Tables

References

Shintani, H, Fujimura, M, Ishiura,, et al (2000) A cause of cigarette smoking-induced acute eosinophilic pneumonia showing tolerance.Chest117,277-279. [CrossRef] [PubMed]
 
Shintan, H, Fujimura, M, Yasu, M, et al Acute eosinophilic pneumonia caused by cigarette smoking.Intern Med2000;39,66-68. [CrossRef] [PubMed]
 
Sasaki, T, Nakajima, M, Kawabata, S, et al Acute eosinophilic pneumonia induced by cigarette smoke [English abstract].Nihon Kyobu Shikkan Gakkai Zasshi1997;35,89-94. [PubMed]
 
Nakajima, M, Manabe, T, Niki, Y, et al Cigarette smoke-induced acute eosinophilic pneumonia.Radiology1998;207,829-831. [PubMed]
 
Nakajima, M, Yoshida, K, Miyashita, N, et al Eosinophilia and cough induced by resumption of cigarette smoking in a beginning smoker recovering from acute respiratory failure [English abstract].Nihon Kokyuki Gakkai Zasshi1999;37,543-548. [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543