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Obstructive Lung Diseases |

Idiopathic Acute Eosinophilic Pneumonia Following Cigarette Smoking With Spontaneous Recovery

Mehdi Shahidi, MD; Suraj Arora, MD; Danxuan Long, MD; Tareq Zaza, MD
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Southern Illinois University School of Medicine, Springfield, IL


Chest. 2013;144(4_MeetingAbstracts):672A. doi:10.1378/chest.1701638
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Abstract

SESSION TITLE: Interstitial Lung Disease Case Report Posters II

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Idiopathic acute eosinophilic pneumonia (IAEP) is a rare disorder with febrile illness and diffuse pulmonary infiltrates followed by acute respiratory failure usually requiring mechanical ventilation and pulmonary eosinophilia. We are presenting a case of IAEP following smoking that spontaneously resolved without the use of corticosteroid therapy.

CASE PRESENTATION: A 20 year old male presented with acute onset of febrile illness and hypoxia. He recently had started smoking. Upon presentation he required six liters of oxygen. Temperature was 38.6 C, heart rate 129 and respiratory rate 26. Examination revealed a moderately distressed patient with clear breath sounds. Laboratory investigations were significant for white cell count of 28.7. Chest x-ray revealed bilateral opacities in the lung. Patient was intubated due to impending respiratory failure and underwent a bronchoscopy with bronchoalveolar lavage (BAL). After two days his leukocytosis and fever resolved and he was extubated. BAL revealed 38% eosinophils, 45% neutrophils with negative stains for any infectious agents. He was diagnosed with IAEP. Furthermore, his peripheral eosinophils increased to 19%. He never received systemic corticosteroids as clinical improvement was achieved.

DISCUSSION: IAEP is a rare but well recognized cause of acute respiratory failure. Etiology of IAEP is unknown, but there is evidence that environmental factors such as industrial smoke inhalation or recent smoking initiation could be the culprits. Diagnostic criteria for IAEP includes presentation with an acute febrile illness followed by hypoxemic respiratory failure, and BAL eosinophils >25%, diffuse pulmonary opacities on chest x-ray and absence of other known causes of eosinophilic pneumonia such as infection or drugs. Our patient fits all the above criteria. Moreover, our patient had recently started smoking which supports the etiologic evidence. Standart treatment is methylprednisolone in the presence of respiratory failure which would result in rapid recovery. However, spontaneous recovery has also been reported. Our patient had complete clinical resolution with spontaneous recovery without steroid use and was successfully extubated.

CONCLUSIONS: We concluded that recent exposure to smoking could be a culprit for IAEP and steroid use may not absolutely be indicated all the time since spontaneous recovery is possible.

Reference #1: Allen JN, Patch ER, Gadek JE, Davis WB. Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure. N Engl J Med 1989; 321:569.

Reference #2: Shiota Y, Kawai T, et al. Acute eosinophilic pneumonia following cigarette smoking. Intern Med 2000, 39:830.

Reference #3: Rhee CK, Min KH, et al. Clinical characteristics and corticosteroid treatment of acute eosinophilic pneumonia. Eur Respir J 2013; 41:402.

DISCLOSURE: The following authors have nothing to disclose: Mehdi Shahidi, Suraj Arora, Danxuan Long, Tareq Zaza

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