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Lung Pathology |

66-Year-Old Man With Chronic Cough and Nodular Airway Lesions FREE TO VIEW

Carlos Martinez-Balzano, MD; Andres Sosa, MD; Sean O'Reilly, MD; Richard Irwin, MD
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Division of Lung, Allergy and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA


Chest. 2015;148(4_MeetingAbstracts):613A. doi:10.1378/chest.2230668
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Abstract

SESSION TITLE: Lung Pathology Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

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

INTRODUCTION: Chronic eosinophilic pneumonia (CEP) is characterized by pulmonary parenchymal disease caused by dense eosinophilic infiltration. We describe an unusual case of CEP presenting with chronic cough and nodular lesions in the airway mucosa.

CASE PRESENTATION: A 66-year-old man presents with a nine month history of relapsing polychondritis (RPC) and severe cough. While symptoms were relieved by prednisone initially, the cough recurred when doses were lowered to less than 30 mg/day. On his clinic visit the patient was not on steroids and his examination revealed diffuse crackles. A chest radiograph showed right upper lobe consolidation. Bronchoscopy revealed multiple nodular and confluent plaque-like lesions in the tracheobronchial mucosa. Bronchoalveolar lavage showed inflammation with 87% eosinophilia. Transbronchial lung biopsies disclosed massive infiltration of eosinophils in the lung parenchyma coalescing to form abscesses. Biopsies of the mucosal lesions also showed eosinophilic abscesses. There was no evidence of recurrent RPC. Other studies were negative for fungal, viral, parasitic or bacterial infection as well as for vasculitides. He was not taking any medications. The patient was diagnosed with CEP and treated with prednisone. There was a dramatic resolution of symptoms within one week.

DISCUSSION: We describe an unusual presentation of CEP based on the occurrence of chronic cough as the sole symptom and nodular endobronchial lesions. Symptoms associated with classic CEP also include progressive dyspnea, malaise, fever and weight loss. Involvement of the airway mucosa, as in our case, has been reported in six CEP cases with similar pathologic findings of eosinophilic infiltration and eosinophilic abscesses. In one case series, these lesions were present 6.8% of the time.1 These findings were associated with higher peripheral neutrophilia and pulmonary eosinophilia. Since not all patients with CEP undergo bronchoscopy, it is possible that the prevalence of airway involvement is higher than currently thought, and even though it appears to resolve with systemic steroids, its true prognostic significance remains unknown.

CONCLUSIONS: CEP can rarely present with lone chronic cough and nodular endobronchial lesions due to eosinophilic infiltration of the airway mucosa. Because these lesions can occur as part of known CEP, their presence should not necessarily mean that another condition exists.

Reference #1: Matsuda Y, et al. Tracheobronchial lesions in eosinophilic pneumonia. Respir Investig. 2014;52:21-7.

DISCLOSURE: The following authors have nothing to disclose: Carlos Martinez-Balzano, Andres Sosa, Sean O'Reilly, Richard Irwin

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