Diffuse Lung Disease: Fellow Case Report Poster - Diffuse Lung Disease I |

Chronic Eosinophilic Pneumonia: An Atypical Radiographic Presentation FREE TO VIEW

Mouhib Naddour, MD; Viral Gandhi, MBBS; Yousef Hattab, MD; Mark Lega, MD
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Allegheny General Hospital, Pittsburgh, PA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):491A. doi:10.1016/j.chest.2016.08.505
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SESSION TITLE: Fellow Case Report Poster - Diffuse Lung Disease I

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Chronic eosinophilic pneumonia (CEP) has been described as the “radiographic negative of pulmonary edema.” We describe a case of CEP with an atypical radiographic pattern.

CASE PRESENTATION: 62 year old women non-smoker presented with three weeks of dyspnea and productive cough. This was associated with anorexia and weight loss. She failed azithromycin therapy. No past medical history or allergies. Physical exam showed diffuse rhonchi throughout the left side. No clubbing, rash or adenopathy. There was peripheral eosinophilia (32%) without leucocytosis. Autoimmune panel (ANCA, Scl-70, ANA, RF), aspergillus antigen and cultures were negative. IgE elevated at 713 IU/ ml. Chest radiograph showed left lung consolidation with clear right lung (Figure 1). CT chest showed extensive left sided consolidation and reactive lymph nodes. Bronchoscopy showed erythema with notable secretions. Bronchoalveolar lavage (BAL) showed 40% eosinophils and 18% lymphocytes. CEP was diagnosed on the basis of peripheral eosinophilia and high eosinophil count in BAL.

DISCUSSION: Chronic eosinophilic pneumonia is characterized by typical pulmonary infiltrate accompanied with lung and blood eosinophilia. The peak incidence is in the fifth decade with women affected more than men. Pre-existing asthma or atopic disease is common. The onset is insidious with repeated courses of antibiotics for non-resolving pneumonia before the diagnosis is reached. Peripheral eosinophilia with elevated IgE levels is common. BAL shows gross eosinophilia (> 25 %) in nearly all patients. The classic pattern of CEP is described as “photographic negative of pulmonary edema” with bilateral peripheral infiltrates. Our patient’s presentation was classic for CEP except what makes this case of interest is that the radiologic presentation was markedly different than as described in literature. This case provides a distinctive reminder that an atypical radiologic pattern should not mislead the clinician from considering CEP, especially with presence of eosinophilia and clinical findings. Corticosteroids are the mainstay of treatment with average duration of treatment being approximately 6 weeks. Relapses are common which may need prolonged treatment up to 18 months.

CONCLUSIONS: The patients was started on prednisone 60 mg/day with dramatic improvement clinically and radiologically (Figure 2) in 7 days.

Reference #1: Luks AM, Altemeier WA. Typical symptons and atypical radiographic findings in a case of chronic eosinophilic pneumonia. Respir Care. 2006 Jul;51(7):764-7

DISCLOSURE: The following authors have nothing to disclose: Mouhib Naddour, Viral Gandhi, Yousef Hattab, Mark Lega

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