Diffuse Lung Disease |

Hook(ah)ed up Pneumocytes FREE TO VIEW

Naveen Yellappa, MBBS; Inam Khan, MD
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Morristown Medical Center, Morristown, NJ

Chest. 2015;148(4_MeetingAbstracts):412A. doi:10.1378/chest.2220919
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SESSION TITLE: Diffuse Lung Disease Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Idiopathic Acute Eosinophilic Pneumonia (AEP) is a rare disease which causes acute respiratory failure and is characterized by eosinophilic infiltrates of pulmonary parenchyma(1). Actual cause of this has remained a mystery with some investigators suggesting an acute hypersensitivity reaction to an unidentified inhaled antigen in an otherwise healthy individual. Here we describe an unusual presentation of AEP in a patient with recent exposure to hookah smoking.

CASE PRESENTATION: 21 year old male with no significant past medical history presented to a health care facility with 3 day history of fever, chills, pleuritic chest pain, fatigue and worsening shortness of breath. On admission patient was found to be hypoxic. As part of his work-up he underwent a chest CT which revealed he had patchy bilateral ground glass opacities. Due to worsening clinical status and possible transition to ARDS, patient was transferred to our hospital for higher level of care. On arrival, patient was intubated for hypoxic respiratory failure. He underwent bronchoscopy which revealed >25% eosinophils in BAL sample. Patient was started on high dose steroids, 1gm per day for 3 days. He was extubated within a week. On further questioning the patient, once his medical status improved, it was revealed that he had been experimenting with smoking for the last few months and had recently been frequenting hookah bars.

DISCUSSION: AEP typically occurs in men in the age group of 20-40. They present as an acute febrile illness with malaise, myalgia, night sweats and pleuritic chest pain. Hypoxic respiratory failure is frequently identified at presentation requiring mechanical ventilation. CT chest findings show bilateral patchy ground glass opacities. Analysis of BAL specimen shows high number of eosinophils (>25%). Diagnosis is based on these factors(1,2). Biopsy is done if diagnosis is unclear. Our patient met all the above mentioned criteria and he responded appropriately to the treatment with high dose steroids. The teaching point is, temporal association with hookah smoking. A few cases have been reported regarding this association(3). A rare albeit important association.

CONCLUSIONS: Acute Eosinophillic Pneumonia is an agressive disease in healthy young adults. It can be effectively managed if diagnosed early. Association with smoking including hookah is an important consideration especially with youngsters frequenting hookah bars more often.

Reference #1: Cordier J-F, Cottin V. 5th, Schwarz MI, King TE Jr. (Eds), People's Medical Publishing House-USA, Shelton, CT 2011. p.833.

Reference #2: Philit F, Etienne-Mastroïanni B, Parrot A, Guérin C, Robert D, Cordier JF Am J Respir Crit Care Med. 2002;166(9):1235.

Reference #3: Hookah, An Unexpected Precipitant Of Acute Eosinophilic Pneumonia Jonathan Hilts,DO, Andrew Skinner,DO,Shashi Bellam,MD Am J Respir Crit Care Med 189;2014:A6487

DISCLOSURE: The following authors have nothing to disclose: Naveen Yellappa, Inam Khan

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