SESSION TYPE: Pleural Cases I
PRESENTED ON: Tuesday, October 23, 2012 at 11:15 AM - 12:30 PM
INTRODUCTION: Exudative eosinophilic predominant pleural effusions are commonly encountered in daily practice.The more common conditions associated with this etiology of exudative effusions are blood or air in the pleural space. Also fungal or parasitic diseases are well known to cause this type of exudative effusions. Here we report the case of a patient with a history of eosinophilic enteritis that was diagnosed with an exudative effusion of eosinophilic predominance during a flare of her disease.
CASE PRESENTATION: A 44 y/o female with a past medical history for eosinophilic enteritis diagnosed by push enteroscopy, had dyspnea at rest and severe dyspnea with mild exertion. No history of recent travel, sick contacts, or previous atopic or pulmonary disease. Her vital signs were significant for hypoxemia at rest to 86% on room air. Her exam was positive for decreased air entry and dullness on percussion in the right hemithorax. CT scan of the thorax showed a very large right sided pleural effusion with collapse of the right lower and middle lobes. The thoracentesis showed serosanguinous pleural fluid analysis with leukocyte count of 3550 and 78% predominance of eosinophils, total protein of 5.2 gm/dL, LDH of 203 IU/L, pH of 7.36, cytology was negative for malignancy. Serum studies showed a total protein of 8.2 gm/dL, LDH of 241. Serology for parasitic disease and stool studies were negative. Negative vasculitis work up. Previous colonoscopy showed no malignancy. Drainage of her pleural effusion and treatment with montelukast and tapering dose steroids led to improvement of her symptoms. Nine days later her symptoms resolved and a repeat chest x-ray showed complete resolution of the pleural effusion.
DISCUSSION: Eosinophilic enteritis is a rare condition with only about 300 cases reported. It is characterized by eosinophilic infiltration of the gastrointestinal tract consisting of 20 or more eosinophils per high-power field and usually with absence of multiorgan involvement with eosinophilia. Also there cannot be an identifiable cause for eosinophilia like parasitic infection or malignancy. It is often accompanied by a history of atopy or allergies especially to food. Eosinophilic ascites and eosinophilic pleural effusions have been described in patients with eosinophilic enteritis. The etiology for the formation of the pleural effusions is currently unknown.
CONCLUSIONS: Exudative pleural effusion can be seen in patients with this eosinophilic enteritis. The effusion can be large as the one seen in our patient and may cause significant respiratory compromise. Treatment of the underlying condition with steroids and leukotriene inhibitors are key to the management of these effusions.
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DISCLOSURE: The following authors have nothing to disclose: Julio Novelo
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