SESSION TYPE: Miscellaneous Student/Resident Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Chronic eosinophilic pneumonia is a syndrome usually associated with atopic manifestations, nonspecific pulmonary manifestations, chest imaging findings suggestive of peripheral alveolar opacities, as well as alveolar and blood eosinophilia. (1) Onset is usually insidious with symptoms lasting up to two to four weeks. Symptoms include dry cough, dyspnea, as well as other systemic manifestations such as fever and weight loss. (2) It is usually idiopathic but can be caused by drugs, allergy shots, parasites, irradiation for breast cancer, or it can be associated with rheumatoid arthritis. (2) In this case, a female patient with a history of allergic rhinitis and breast cancer developed CEP six years after she completed radiation therapy.
CASE PRESENTATION: A 51-year- old female with a medical history significant for left sided breast cancer underwent a mastectomy and radiation treatment. She completed radiation therapy in 2005. She presented in February 2012 with a three-month history of shortness of breath on exertion. Pulmonary function tests were normal. High resolution CT of the chest was significant for ground glass opacification in the left base. She was found to have significant eosinophilia on bronchoalveolar lavage fluid (37%). Histopathology was significant for focal organizing pneumonia and mild chronic inflammatory infiltrates with rare eosinophils. She was treated with oral Prednisone at 1 mg/kg with significant improvement in symptoms.
DISCUSSION: Chronic eosinophilic pneumonia has been reported following radiation therapy after mastectomy particularly in patients with a history of asthma and/or allergies. (1) Diagnosis is usually made based on clinical criteria, radiological findings, as well as eosinophilia present either in blood or in bronchoalveolar lavage. BAL findings include eosinophilia with counts more than 25 % in all cases. The response to steroids aids in confirming the diagnosis. Response to treatment is usually within 24 to 48 hours with dramatic improvement in symptoms. (2)Case reports show a median presentation of symptoms 3.5 months from the completion of radiation therapy. (1) Our patient met with all the above mentioned criteria thus meeting the diagnosis of CEP; however she presented six years after the completion of her radiation therapy.
CONCLUSIONS: This case report should alert clinicians in general and pulmonologists in particular, to consider chronic eosinophilic pneumonia as a diagnosis in patients who had previous exposure to radiation therapy irrespective of the time of exposure
1) Cottin V., Frognier R., Monnot H et al. Chronic eosinophylic pneumonia after radiation therapy for breast cancer. Eur Resp J 2004; 23: 9 - 13
2) Campos L., Pereira L. Pulmonary Eosinophilia, J Bras Pneumol. 2009; 35 (6): 561 -573
DISCLOSURE: The following authors have nothing to disclose: Said Chaaban, Victor Salloum
No Product/Research Disclosure InformationUniversity of Kansas School of Medicine, Wichita, KS