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chronic eosinophilic pneumonia
Epidemiology:
1) > 50% have asthma of > 5 years duration
2) female:male rato of 2:1
3) most common in middle-aged women
Pathology:
1) high tissue eosinophilia
2) bronchiolitis obliterans with organizing pneumonia (BOOP) ;
* histology images [3]
Clinical manifestations:
1) insidious onset
2) average duration of symptoms before diagnosis is made is 7 months
3) cough (90%)
4) fever (85%)
5) dyspnea (60%), generally exertional dyspnea
6) wheezing (35%)
7) weight loss (56%) long-term smoker
8) night sweats
Laboratory:
1) complete blood count (CBC) with differential
a) high eosinophilia > 40%
b) anemia
c) thrombocytosis
2) serum IgE levels is increased in 65% of patients
3) erythrocyte sedimentation rate (ESR) is increased in most patients
4) iron studies: iron-deficiency anemia
Special laboratory:
- bronchoscopy makes diagnosis
a) bronchial alveolar lavage (BAL): high eosinophil count
b) biopsy generally not necessary
Radiology:
1) chest X-ray:
a) bilateral peripheral alveolar infiltrates
b) 'photographic negative' of pulmonary edema
2) computed tomography (CT):
- ground-glass peripheral infiltrates
Management:
1) long term (> 6 months) of corticosteroid therapy
2) good response to steroids
Related
bronchiolitis obliterans; constrictive bronchiolitis; cryptogenic organizing pneumonia; bronchiolitis obliterans with organizing pneumonia (BOOP)
eosinophilic bronchitis
General
eosinophilic pneumonia; Andrews syndrome; pulmonary eosinophilia
chronic lung disease
References
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 754
- Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 18.
American College of Physicians, Philadelphia 1998, 2006, 2018.
- Saukkonen K, Sharma A, Mark EJ (histology images)
Case 8-2016. A 71-Year-Old Man with Recurrent Fevers,
Hypoxemia, and Lung Infiltrates.
N Engl J Med 2016; 374:1077-1085. March 17, 2016
PMID: 26981938
http://www.nejm.org/doi/full/10.1056/NEJMcpc1505680