EOSINOPHILIC PNEUMONIA-A CASE REPORT

S.Nisha Parveen , N.N. Ramraje, J.M. Phadtare ,Priti L. Meshram,Rohit R. Hegde

Department of Pulmonary Medicine, Grant Govt Medical College and Sir JJ group of Hospitals, Mumbai

INTRODUCTION
The term eosinophilic pneumonia describes a group of entities characterized by
accumulation of eosinophils in the pulmonary interstitium and air spaces.
Eosinophilic pneumonia was first described as a cause of respiratory failure in
1989[1,2]. Subsequently, cases of eosinophilic pneumonia have been reported
worldwide.

Fig:1: chest X-ray showing Fig:2 HRCT:s/o bilateral upper Fig:3:Chest X-ray showing
CASE REPORT bilateral upper lobe infiltration lobes ground glass opacities resolution after steroids
A 40 year old female known diabetic presented with dry cough and
breathlessness since 3 months. No past history of TB. On examination pulse- TREATMENT
108/min, BP-110/70mmHg, Respiratory rate-24/min, SpO2-95%@RA. On
respiratory sytem examination bilateral crepitations heard in infraclavicular, A diagnosis of eosinophilic pneumonia was established and she was started on inhaled
infraaxillary and infrascapular area bilaterally. ICS+LABA combination, oral steroids and diethyl carbamazine. Her clinical condition
improved, and after 3 weeks a repeat Chest X ray was indicative of clearance of
INVESTIGATIONS pulmonary lesions and repeat CBC showed resolution of the peripheral
eosinophilia(2%).
Hb-10.9g%
WBC-15000 /cumm
eosinophilia(19%)
Absolute eosinophil count-2850 /cumm
DISCUSSION
FBS-128mg% CEP was first described as a clinical entity by Carrington et al in 1969. The clinical
PPBS-232mg% picture is fever, weight loss and shortness of breath. Most patients are middle aged
HbA1C-6.5% and women are more frequently affected. Typical chest x-ray is non segmental
Serum IgE-541 UI/ml infiltration with peripheral predominance(“photographic” negative of pulmonary
Stool routine microscopy- no ova/cysts/parasites seen edema) seen only in 50% of patients. HRCT demonstrates patchy consolidation with
CXR-PA view-bilateral upper zone infiltration peripheral and upper lobe predominance, b) ground glass opacities with crazy paving,
HRCT Thorax- bilateral upper lobe ground glass opacities with smooth c) bandlike subpleural opacities. Although peripheral eosinophilia is common feature it
interlobular, interstitial thickening in with subpleural predominance could be absent. In such cases a finding of 20% or more eosinophils in BAL is almost
PFT-Mixed ventilatory defect pattern with good bronchodilator reversibility associated with eosinophilic alveolitis. The prognosis of eosinophilic pneumonia is
of obstructive element. good on treatment with corticosteroids.
Bronchoscopy was performed.
BAL Routine microscopy-TLC-200/cumm CONCLUSION
eosinophilia(65%)
BAL absolute eosinophil count- 130/cumm Eosinophilic pneumonia is a rare disease and should be considered in differential
BAL gene xpert-MTB not detected diagnosis of pulmonary infiltration associated with peripheral blood eosinophilia.
BAL fungal culture-no growth
REFERENCES
1. Allen JN, Pacht ER, Gadek JE, Davis WB. Acute eosinophilic pneumonia as a
reversible cause of noninfectious respiratory failure. N Engl J Med. 1989;321:569–574.
2. Badesch DB, King TE, Jr, Schwarz MI. Acute eosinophilic pneumonia: a
hypersensitivity phenomenon? Am Rev Respir Dis. 1989;139:249–252