Acute eosinophilic pneumonia aep is an uncommon lung disease. The challenge lies in the timely diagnosis of this clinical entity due to its resemblance with infectious pneumonia or ards. Associations for the condition also exist with cml, hiv infection and. We report a case of acute eosinophilic pneumonia aep. Acute eosinophilic pneumonia pulmonary disorders msd. Aep may be idiopathic, but identifiable causes include smoking and other inhalational exposures, medications, and infections. Two major types of ep are acute eosinophilic pneumonia. Clinical characteristics and corticosteroid treatment of. Use of vivitrol should be discontinued in the event of symptoms andor signs of acute hepatitis. Acute eosinophilic pneumonia is characterized by acute respiratory insufficiency, hypoxemia, fever, diffuse radiographic infiltrates, and eosinophilia in bronchoalveolar lavage fluid balf or. We believe this is the 8th definite case of daptomycininduced acute eosinophilic pneumonia to be reported in the literature. Twelve consecutive patients with acute eosinophilic pneumonia were included in the study.
Acute eosinophilic pneumonia aep is an uncommon acute respiratory illness of varying severity that includes presentation as. In contrast to chronic eosinophilic pneumonia, acute eosinophilic pneumonia is an acute illness that does not usually recur. We present the case reports of two children with a parasitic infestation associated with hypereosinophilia. Acute eosinophilic pneumonia is a type of eosinophilic lung disease diagnosed when the following combination of clinical and radiographic findings occur 5,7. Acute eosinophilic pneumonia after resumption of cigarette. Acute eosinophilic pneumonia aep is an uncommon acute respiratory illness of varying severity that includes presentation as acute respiratory distress syndrome with fatal outcome. Acute eosinophilic pneumonia should be considered as a possible diagnosis when a previously healthy person presents with acute respiratory failure of unknown origin. Aep can be idiopathic, but identifiable causes include medications and inhalational exposures, including cigarette smoke. Daptomycin is a cyclic lipopeptide antibiotic with great efficacy targeting grampositive cocci, including methicillinresistant staphylococcus aureus and vancomycinresistant enterococcus. Acute eosinophilic pneumonia accompanied with covid. Often, aep rapidly leads to acute respiratory distress syndrome which is a lifethreatening. Hematoxylineosin stain of a lung biopsy specimen from the patient in case 3 at original magni.
Acute eosinophilic pneumonia aep is an inflammation of the lungs characterized by eosinophilia. Nov 16, 2020 acute eosinophilic pneumonia aep is an acute rare lung disease characterized by respiratory failure and consolidation and diffuse ground. The level of oxygen in the blood can decrease severely, and acute eosinophilic pneumonia can progress to acute respiratory failure in a few hours or days if not treated. Idiopathic acute eosinophilic pneumonia can occur at any age but is more common in males of age 2040 years. This is an important disorder to be aware of because, if treated aggressively with steroid, patients will rapidly recover. Acute eosinophilic pneumonia should be considered in cases of pneumonia that continue to worsen despite the treatment of iv antibiotics. Eotaxinccl11, the most potent chemokine for eosinophils, was exclusively elevated in the bal fluids of patients with eosinophilic pneumonia. Lymphocytic interstitial pneumonia applies to disorders associated with both monoclonal or polyclonal gammopathy. Diagnostic pitfalls of acute eosinophilic pneumonia in an ad.
At the time of initial presentation, aep may be indistinguishable from communityacquired pneumonia cap or ards, potentially causing. Here we present an unreported case of a 46yearold female who developed acute eosinophilic pneumonia after avian exposure. American journal of respiratory and critical care medicine 155 1997. Aug 01, 2017 acute eosinophilic pneumonia aep is an uncommon lung disease, first described in 1989,1, 2 and characterized by acute febrile illness, diffuse bilateral lung opacities, and pulmonary eosinophilia. Acute eosinophilic pneumonia aep is characterized by acute febrile respiratory symptoms, bilateral lung infiltrates, and pulmonary eosinophilia. The new berlin definition of ards reflects a range of. Acute eosinophilic pneumonia radiology reference article. Idiopathic acute eosinophilic pneumonia iaep is a treatable cause of acute hypoxic respiratory failure. Acute eosinophilic pneumonia following inhalation of.
Conversely, acute eosinophilic pneumonia aep is characterized by a more rapid onset of symptoms and can be seen with fever and diffuse infiltrates on imaging. Daptomycininduced acute eosinophilic pneumonia cid 2010. Acute eosinophilic pneumonia associated with smoke from. Acute disease, pulmonary eosinophilia, respiratory insufficiency, smoking, treatment outcome a cute eosinophilic pneumonia aep is an acute febrile illness with severe hypoxaemia, diffuse pulmonary infiltrates, an increase in bronchoalveolar lavage bal eosinophils and no evidence of infection or previous atopic illness 1. It may cause fever, chest pain worsened by deep breathing, shortness of breath, cough, and a general feeling of illness. Another distinguishing feature of acute eosinophilic pneumonia is the complete recovery of both symptoms and xray abnormalities without recurrence or residual sequelae, within weeks of treatment. Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure. Jan 01, 2018 acute eosinophilic pneumonia was first described in 1989 103 and is characterized by acute respiratory failure, fever of days to weeks duration, diffuse pulmonary infiltrates on radiologic studies, and eosinophilia in bronchoalveolar lavage fluid or lung biopsy specimens in the absence of infection, atopy, and asthma. Clinical implications of initial peripheral eosinophilia. Secondhand tobacco smoke and acute eosinophilic pneumonia abstract. Mar 17, 2021 acute eosinophilic pneumonia aep is a rare inflammatory lung disease, which can cause younger adults to develop respiratory failure requiring intubation.
Author disclosures the authors report no actual or potential conflicts of interest with regard to this article. Acute eosinophilic pneumonia aep is a rare inammator y lung disease, which can cause y ounger adults to develop respirator y failure requiring intubation. He showed leukocytosis of 16,200microl and hypoxemia of 58. While the exact incidence is unknown, a study on military personnel deployed near iraq reported 9. Acute eosinophilic pneumonia aep is a rare cause of acute hypoxic respiratory failure. Reports have identified cases caused by environmental inhalational exposures that lead to an overwhelming immune response. Although the patient had been a habitual cigarette smoker for over 4 months, he had had not any respiratory distress. Two major types of ep are acute eosinophilic pneumonia aep and chronic eosinophilic pneumonia cep, both of which are characterized by marked accumulation of eosinophils in lung tissues andor bal fluid. One of those patients, who had been exposed to excessive secondhand tobacco smoke, was diagnosed as having acute eosinophilic pneumonia. Other drugs that may commonly cause a syndrome corresponding to acute eosinophilic pneumonia 80 notably include amitriptyline 81, nitrofurantoin 82, phenytoin 83, acetaminophen 84. Acute eosinophilic pneumonia aep is an acute febrile illness with severe hypoxaemia, diffuse pulmonary infiltrates, an increase in bronchoalveolar lavage bal eosinophils and no evidence of infection or previous atopic illness. Eosinophilic pneumonia lung and airway disorders merck. Circulating thymus and activationregulated chemokineccl17. Patients with aep frequently show hypoxaemic respiratory dysfunction and often re.
Acute eosinophilic pneumonia is a type of eosinophilic lung disease diagnosed when the following combination of clinical and radiographic findings occur 5,7 febrile illness of less than five days duration. Jan 01, 2020 acute eosinophilic pneumonia aep is characterized by acute onset, severe dyspnea, diffuse consolidation on chest radiographs, or symptomatic and radiographic resolution of pneumonia following steroid treatment. Aep is a type of eosinophilic lung disease which presents with acute respiratory failure and has an excellent prognosis if treated appropriately with corticosteroids. Idiopathic acute eosinophilic pneumonia bmj case reports. Acute eosinophilic pneumonia is very responsive to steroids and the prognosis is excellent. Table 1 diagnostic criteria of acute eosinophilic pneumonia. Objectives todescribeacaseseriesofaep,illustratetheclinicalfeaturesofthissyndrome, and report the results of an epidemiologic investigation.
Daptomycininduced acute eosinophilic pneumonia wisconsin. Acute eosinophilic pneumonia secondary to daptomycin. These cells cause disruption of the normal air spaces where oxygen is extracted from the atmosphere. Daptomycin is one of the main antibiotics known to have several adverse effects, including druginduced pulmonary eosinophila. Idiopathic acute eosinophilic pneumonia iaep is a rapidly progressive disease of healthy adults, described in 1989. Pathologic changes include acute organizing pneumonia, eosinophilia, chronic in.
Acute eosinophilic pneumonia aep is an uncommon disease, often indistinguishable from ards or communityacquired pneumonia at initial presentation. Acute eosinophilic pneumonia among us military personnel. This contrasts with acute eosinophilic pneumonia in which a smoking history is much more common. This is an impor tant disorder to be aware of because, if treated aggressively with steroid, patients will rapidly recover. At the time of initial presentation, aep may be indistinguishable from communityacquired pneumonia cap or ards, potentially causing misdiagnosis. Acute eosinophilic pneumonia associated with smoking. A 61yearold woman with poorly con trolled type 2 diabetes, complicated by nephropathy and. A case of passive smoking and eosinophilic pneumonia turk j med sci references 1. Although the disease is rare, it will be encountered with some regularity e. Acute eosinophilic pneumonia aep is a disease characterized by an acute febrile onset, eosinophilia in bronchoalveolar lavage fluid, and a dramatic response to corticosteroids. Clinical implications of initial peripheral eosinophilia in. Acute eosinophilic pneumonia aep is a rare but severe respiratory syndrome characterized by fever, hypoxemic respiratory failure, diffuse pulmonary infiltrates, and pulmonary eosinophilia. Contextacute eosinophilic pneumonia aep is a rare disease of unknown etiology characterized by respiratory failure, radiographic infiltrates, and eosinophili. Eosinophilic lung diseases are a diverse group of pulmonary disorders associated with peripheral or tissue eosinophilia.
However, there have been few instances where the treatment is the cause of pulmonary symptoms, manifesting as socalled multifocal pneumonia. We believe this is the 8th definite case of daptomycininduced acute eosinophilic pneumo. Of these, 38 were possible, were probable, and 7 were definite. Lymphocytic interstitial pneumonia lip is a syndrome secondary to autoimmune and other lymphoproliferative disorders. Acute eosinophilic pneumonia, respiratory failure, eosinophil. Eosinophilic pneumonia in clinical trials with vivitrol, there was one diagnosed case and one suspected case of eosinophilic pneumonia. Pdf acute eosinophilic pneumonia is a severe and rapidly progressive lung disease that can cause fatal respiratory failure.
Eosinophilic pneumonia ep is a rare disorder, comprising several heterogeneous diseases. Introduction eosinophilic pneumonia refers to a spectrum of diseases that have the potential to cause eosinophilic infiltration of the lung parenchyma as well as the peripheral blood. The patient did not improve despite treatment, and hence a high resolution ct hrct scan of the. Acute eosinophilic pneumonia aep, age distribution, bronchoscopy, corticosteroid, seasonality background acute eosinophilic pneumonia aep is a rare disease that was originally reported by badesch et al. Acute eosinophilic pneumonia aep is an acute febrile illness with severe hypoxaemia, diffuse pulmonary.
The most common cause of aep is idiopathic, but it can be associated with antidepressant medications like sertraline. Acute eosinophilic pneumonia can occur at any age but most often affects patients between 20 and 40 years, with a maletofemale ratio of 2. In all patients, airspace disease markedly improved within 3 days of initiation of treatment with corticosteroids. Secondhand tobacco smoke and acute eosinophilic pneumonia. Acute eosinophilic pneumonia is a rare complication of daptomycin therapy, with a poorly understood etiology thought to involve the accumulation of the drug in pulmonary surfactant inducing inflammation. Idiopathic acute eosinophilic pneumonia can occur at any age but is more common in males. The chest xray cxr revealed symmetrical, perihilar airspace shadowed with peribronchial cuffing and bilateral reticular markings. A pubmed search from 1989 to 2008 was conducted using the search terms acute eosinophilic pneumonia, respiratory failure, eosinophilic lung disease. Eosinophilic pneumonia is a disease in which an eosinophil, a type of white blood cell, accumulates in the lungs. Acute eosinophilic pneumonia is a severe and rapidly progressive lung disease that can cause fatal respiratory failure. Eosinophilia is a sign of inflammation in the body. Acute eosinophilic pneumonia nord national organization. Clinical characteristics and corticosteroid treatment of acute.
Acute eosinophilic pneumonia after recent start of smoking. Acute eosinophilic pneumonia is an uncommon respiratory condition whose etiology is unclear. Sep 01, 2018 acute eosinophilic pneumonia aep is a severe, rapidly progressive lung disease that, if not recognized or treated, can result in fatal respiratory failure. Eosinophilic pneumonias the journal of allergy and clinical. Symptoms include fever, cough, and shortness of breath. In acute eosinophilic pneumonia aep, initial peripheral eosinophil count pec is rarely elevated and tends to increase during clinical course. Daptomycininduced acute eosinophilic pneumonia is rare. A case of acute eosinophilic pneumonia with hypersensitivity to red.
The diagnosis was based on clinical symptoms and results of bronchoalveolar lavage. Acute eosinophilic pneumonia secondary to menthol cigarette. After he inhaled smoke from fireworks for 3 consecutive nights, the patient began to complain of cough, fever and dyspnea. Pdf eosinophilic pneumonia ep is a rare disorder, comprising several heterogeneous diseases. The precise pathogenesis and etiology of aep is still unknown, but there is some correlation between aep and preceding exposure to inhalational agents, such as cigarette smoke. The pathogenesis of aep is poorly understood but likely varies depending on the. To determine the radiographic and computed tomographic ct characteristics of acute eosinophilic pneumonia. Popeharman al, davis wb, allen ed, christoforidis aj, allen jn.
Apr 02, 2021 context acute eosinophilic pneumonia aep is a rare disease of unknown etiology characterized by respiratory failure, radiographic infiltrates, and eosinophilic infiltration of the lung. Idiopathic acute eosinophilic pneumonia aep was first proposed as a cause of acute respiratory failure in 1989. Acute eosinophilic pneumonia pulmonary disorders merck. The clinical course is often chronic with persistent or recurrent presence of. Eosinophilia is the presence of an abnormally high number of eosinophils a type of white blood cell. Antibiotic use in pneumonia is a common practice globally when there is suspicion for bacterial involvement. Cureus daptomycininduced acute eosinophilic pneumonia.
Although many studies have reported a close relationship between direct cigarette smoking and aep, few studies have identified an association between passive smoking and aep. Acute eosinophilic pneumonia chest journal american college. Here, in patients with aep, initial peripheral eosino. Oct 01, 2019 eosinophilic pneumonia ep is a rare disorder, comprising several heterogeneous diseases. Acute eosinophilic pneumonia aep and new onset smoking. Eosinophilic pneumonia is characterized by in filtration of the lungs by eosinophils. A 44yearold asthmatic male patient presented to the health centre with a 3week history of coryzal symptoms, persistent productive sputum and shortness of breath.
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