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Caminati M, Brussino L, Carlucci M, Carlucci P, Carpagnano LF, Caruso C, Cosmi L, D’Amore S, Del Giacco S, Detoraki A, Di Gioacchino M, Matucci A, Mormile I, Granata F, Guarnieri G, Krampera M, Maule M, Nettis E, Nicola S, Noviello S, Pane F, Papayannidis C, Parronchi P, Pelaia G, Ridolo E, Rossi FW, Senna G, Triggiani M, Vacca A, Vivarelli E, Vultaggio A, de Paulis A. Managing Patients with Hypereosinophilic Syndrome: A Statement from the Italian Society of Allergy, Asthma, and Clinical Immunology (SIAAIC). Cells 2024; 13:1180. [PMID: 39056762 PMCID: PMC11274683 DOI: 10.3390/cells13141180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/07/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Hypereosinophilic syndrome (HES) encompasses a heterogeneous and complex group of different subtypes within the wider group of hypereosinophilic disorders. Despite increasing research interest, several unmet needs in terms of disease identification, pathobiology, phenotyping, and personalized treatment remain to be addressed. Also, the prospective burden of non-malignant HES and, more in general, HE disorders is currently unknown. On a practical note, shortening the diagnostic delay and the time to an appropriate treatment approach probably represents the most urgent issue, even in light of the great impact of HES on the quality of life of affected patients. The present document represents the first action that the Italian Society of Allergy, Asthma, and Clinical Immunology (SIAAIC) has finalized within a wider project aiming to establish a collaborative national network on HES (InHES-Italian Network on HES) for patients and physicians. The first step of the project could not but focus on defining a common language as well as sharing with all of the medical community an update on the most recent advances in the field. In fact, the existing literature has been carefully reviewed in order to critically integrate the different views on the topic and derive practical recommendations on disease identification and treatment approaches.
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Affiliation(s)
- Marco Caminati
- Asthma Centre and Allergy Unit, Center for Hypereosinophilic Dysimmune Diseases, Department of Medicine, University of Verona, 37124 Verona, Italy; (M.C.); (M.M.); (G.S.)
| | - Luisa Brussino
- SSDDU Immunologia Clinica ed Allergologia, AO Mauriziano, 10128 Turin, Italy; (L.B.); (S.N.)
| | - Matilde Carlucci
- Health Directorate, Verona Integrated University Hospital, 35134 Verona, Italy;
| | - Palma Carlucci
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, 70126 Bari, Italy; (P.C.); (E.N.)
| | | | - Cristiano Caruso
- Allergologia dell’Istituto di Clinica Medica del Policlinico Gemelli, Università Cattolica di Roma, 00168 Rome, Italy;
- UOSD DH Internal Medicine and Digestive Disease, Fondazione Policlinico A Gemelli IRCCS, 00168 Rome, Italy
| | - Lorenzo Cosmi
- Department Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (L.C.); (P.P.)
- Immunoallergology Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Simona D’Amore
- Department of Precision and Regenerative Medicine and Ionian Area, UOC Medicina Interna “Guido Baccelli”, University of Bari Aldo Moro, Policlinico, 70126 Bari, Italy; (S.D.); (S.N.); (A.V.)
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy;
| | - Aikaterini Detoraki
- Division of Internal Medicine and Clinical Immunology, Department of Internal Medicine and Clinical Complexity University of Naples Federico II, 80138 Naples, Italy;
| | - Mario Di Gioacchino
- Center for Advanced Studies and Technology (CAST), G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
- Institute of Clinical Immunotherapy and Advanced Biological Treatments, 66100 Pescara, Italy
| | - Andrea Matucci
- Immunoallergology Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Ilaria Mormile
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy; (F.G.); (F.W.R.); (A.d.P.)
| | - Francescopaolo Granata
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy; (F.G.); (F.W.R.); (A.d.P.)
| | - Gabriella Guarnieri
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona, 37129 Verona, Italy; (G.G.); (M.K.)
| | - Mauro Krampera
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona, 37129 Verona, Italy; (G.G.); (M.K.)
| | - Matteo Maule
- Asthma Centre and Allergy Unit, Center for Hypereosinophilic Dysimmune Diseases, Department of Medicine, University of Verona, 37124 Verona, Italy; (M.C.); (M.M.); (G.S.)
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, 70126 Bari, Italy; (P.C.); (E.N.)
| | - Stefania Nicola
- SSDDU Immunologia Clinica ed Allergologia, AO Mauriziano, 10128 Turin, Italy; (L.B.); (S.N.)
| | - Silvia Noviello
- Department of Precision and Regenerative Medicine and Ionian Area, UOC Medicina Interna “Guido Baccelli”, University of Bari Aldo Moro, Policlinico, 70126 Bari, Italy; (S.D.); (S.N.); (A.V.)
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, University Federico II, 80138 Naples, Italy;
| | - Cristina Papayannidis
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia “Seràgnoli”, 40126 Bologna, Italy;
| | - Paola Parronchi
- Department Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (L.C.); (P.P.)
- Immunology and Cell therapies Unit, University Hospital Careggi, 50134 Florence, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy;
| | - Erminia Ridolo
- Department of Clinical and Experimental Medicine, University of Parma, 43124 Parma, Italy;
| | - Francesca Wanda Rossi
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy; (F.G.); (F.W.R.); (A.d.P.)
- Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131 Naples, Italy
- WAO Center of Excellence, 80131 Naples, Italy
| | - Gianenrico Senna
- Asthma Centre and Allergy Unit, Center for Hypereosinophilic Dysimmune Diseases, Department of Medicine, University of Verona, 37124 Verona, Italy; (M.C.); (M.M.); (G.S.)
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, 84084 Fisciano, Italy;
| | - Angelo Vacca
- Department of Precision and Regenerative Medicine and Ionian Area, UOC Medicina Interna “Guido Baccelli”, University of Bari Aldo Moro, Policlinico, 70126 Bari, Italy; (S.D.); (S.N.); (A.V.)
| | - Emanuele Vivarelli
- Department of Biomedicine, Azienda Ospedaliero Universitaria Careggi, 50134 Florence, Italy; (E.V.); (A.V.)
| | - Alessandra Vultaggio
- Department of Biomedicine, Azienda Ospedaliero Universitaria Careggi, 50134 Florence, Italy; (E.V.); (A.V.)
| | - Amato de Paulis
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy; (F.G.); (F.W.R.); (A.d.P.)
- Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131 Naples, Italy
- WAO Center of Excellence, 80131 Naples, Italy
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Abdelghany Y, Glick DR, Cutler T. A case of naltrexone-induced acute eosinophilic pneumonia. BMJ Case Rep 2024; 17:e259324. [PMID: 38697684 PMCID: PMC11085909 DOI: 10.1136/bcr-2023-259324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
Acute eosinophilic pneumonia (AEP) is a rare cause of acute respiratory failure. Clinical presentations can range from dyspnoea, fever and cough, to rapidly progressive and potentially fulminant respiratory failure. While its exact cause is often unknown, associations with inhalational injuries and exposures to new medications have been described.We report a case of a middle-aged, non-smoking man with a history of alcohol use disorder. He presented with 4 days of shortness of breath that started hours after taking injectable naltrexone (Vivitrol). The patient had rapidly worsening hypoxaemia, necessitating emergent bronchoscopy with transbronchial biopsies and bronchoalveolar lavage which showed 66% eosinophils. The patient was intubated for the procedure and unable to get extubated due to worsening hypoxaemic respiratory failure with high fractional inspired oxygen requirements. Chest radiograph showed worsening lung infiltrates and with a high index of suspicion for AEP, he was started empirically on methylprednisolone. He had rapid improvement in his respiratory status and was extubated on day 5 of admission then discharged on day 8. Histopathological examination confirmed acute/subacute eosinophilic pneumonia. A 3-week post-discharge follow-up chest radiograph confirmed the full resolution of pulmonary infiltrates.Naltrexone-induced AEP is rare, with only six other cases reported in the literature. Careful history taking and prompt evaluation for AEP are important given the potential for rapid progression to acute hypoxic respiratory failure and the excellent response to steroid treatment.
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Affiliation(s)
- Youmna Abdelghany
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Internal Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Danielle Renee Glick
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Todd Cutler
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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Li S, Fang M, Guo H, Yu T, Wang J, Li W, Huang Y, Wang X, Wu R. Eosinophilic pulmonary disease with ulcerative colitis: A case report. Medicine (Baltimore) 2024; 103:e37851. [PMID: 38669413 PMCID: PMC11049983 DOI: 10.1097/md.0000000000037851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
RATIONALE Eosinophilic pulmonary disease (EPD) is a general term for a large group of diseases with complex etiology. Ulcerative colitis is an inflammatory bowel disease (IBD). Patients with IBD may have pulmonary involvement. We herein present a case of ulcerative colitis complicated with EPD. PATIENT CONCERNS A 34-year-old woman with ulcerative colitis presented with dry cough. She had peripheral eosinophilia and apical ground glass opacities on CT (computed tomography) of her chest. Antibiotic treatment was ineffective. DIAGNOSES Lung biopsy revealed eosinophil infiltration in the alveolar space and interstitial space, so EPD was considered. INTERVENTIONS After oral administration of prednisone, the lung shadow on CT disappeared when the cough symptoms resolved. However, the symptoms recurred after drug withdrawal, and the lung shadow reappeared on imaging. The cough symptoms and lung shadow disappeared after oral prednisone was given again. Prednisone was slowly discontinued after 6 months of treatment. OUTCOMES The patient stopped prednisone for half a year. No recurrence or abnormal CT findings were detected during the half-year follow-up. LESSONS The clinical manifestations of EPD are atypical, laboratory and imaging findings are not specific, and it is difficult to make a definite diagnosis before lung biopsy. The diagnosis depends on pathological examination. Glucocorticoid treatment is effective, but some patients may relapse after drug withdrawal. Active follow-up after glucocorticoid treatment is very important for identifying disease recurrence. Patients with IBD are relatively prone to developing EPD. The etiology of EPD is complex. In clinical practice, we need to make a diagnosis and differential diagnosis to clarify its etiology.
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Affiliation(s)
- Songtao Li
- Department of Respiratory and Critical Care Medicine, The 6th People’s Hospital of Chengdu, Chengdu 610051, China
| | - Mingliang Fang
- Department of Cardiovascular Medicine, The second People’s Hospital of Chengdu, Chengdu 610017, China
| | - Hua Guo
- Department of Respiratory and Critical Care Medicine, The 6th People’s Hospital of Chengdu, Chengdu 610051, China
| | - Tian Yu
- Department of Respiratory and Critical Care Medicine, The 6th People’s Hospital of Chengdu, Chengdu 610051, China
| | - Jun Wang
- Department of Respiratory and Critical Care Medicine, The 6th People’s Hospital of Chengdu, Chengdu 610051, China
| | - Weiming Li
- Department of Respiratory and Critical Care Medicine, The 6th People’s Hospital of Chengdu, Chengdu 610051, China
| | - Yunong Huang
- Department of Radiology, The 6th People’s Hospital of Chengdu, Chengdu 610051, China
| | - Xichuan Wang
- Department of Pathology, The 6th People’s Hospital of Chengdu, Chengdu 610051, China
| | - Rongyi Wu
- Department of Pathology, The 6th People’s Hospital of Chengdu, Chengdu 610051, China
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Carbone RG, Puppo F, Mattar E, Roden AC, Hirani N. Acute and chronic eosinophilic pneumonia: an overview. Front Med (Lausanne) 2024; 11:1355247. [PMID: 38711783 PMCID: PMC11070545 DOI: 10.3389/fmed.2024.1355247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/05/2024] [Indexed: 05/08/2024] Open
Abstract
Acute and chronic eosinophilic pneumonia (AEP and CEP) include a group of rare interstitial lung diseases characterized by peripheral blood eosinophilia, increased eosinophils in bronchoalveolar lavage fluid, or eosinophilic infiltration of lung parenchyma. AEP is characterized by rapid onset, fast response to steroid treatment, and no relapse. CEP is characterized by marked tissue and peripheral blood eosinophilia, rapid response to steroid therapy, and tendency to disease recurrence. In addition, we briefly describe other eosinophilic lung diseases that must be considered in differential diagnosis of AEP and CEP. Eosinophilic pneumonias may be idiopathic or due to known causes such as medications or environmental exposure. At variance with previous reviews on this topic, a particular look in this overview was directed at pathological findings and radiological patterns.
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Affiliation(s)
| | - Francesco Puppo
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Eduardo Mattar
- Cardiothoracic Imaging, University of Washington, Seattle, WA, United States
| | - Anja C. Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Nikhil Hirani
- Center for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
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Hassett MR. Daptomycin-induced eosinophilic pneumonia. JAAPA 2024; 37:1-4. [PMID: 38531037 DOI: 10.1097/01.jaa.0001005632.20281.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
ABSTRACT Daptomycin-induced eosinophilic pneumonia (DIEP) is a rare complication of daptomycin use. Manifestations most commonly include fever, hypoxia, dyspnea, cough, eosinophilia, and lung changes on radiographs and CT. Patients typically have had recent daptomycin exposure and develop fever, dyspnea, infiltrates on chest radiograph, more than 25% eosinophils on bronchoalveolar lavage, and improvement of symptoms after withdrawal of daptomycin. Treatment includes discontinuation of daptomycin, corticosteroids, and supportive measures such as supplemental oxygen. Clinicians should have a high index of suspicion for DIEP in patients who develop new onset of pulmonary and systemic signs and symptoms after initiation of daptomycin.
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Affiliation(s)
- Michael R Hassett
- Michael R. Hassett practices at the Centers for Advanced Orthopaedics-MMI Division in Frederick, Md. The author has disclosed no potential conflicts of interest, financial or otherwise
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Ogata H, Koga C, Yanagihara T, Moriuchi Y, Enokizu‐Ogawa A, Ishimatsu A, Otsuka J, Taguchi K, Moriwaki A, Tokunaga E, Yoshida M. Relapsing eosinophilic pneumonia in a patient with recurrent breast cancer receiving abemaciclib plus endocrine therapy. Respirol Case Rep 2024; 12:e01320. [PMID: 38455504 PMCID: PMC10918717 DOI: 10.1002/rcr2.1320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024] Open
Abstract
This report presents the case of a 42-year-old Japanese woman with recurrent hormone receptor-positive breast cancer who developed eosinophilic pneumonia (EP) during treatment with abemaciclib combined with endocrine therapy. Seven years after a radical surgery and definite diagnosis of Stage I breast cancer, her cancer recurred with metastases to multiple organs. Initially treated with abemaciclib plus letrozole and goserelin for 3 months, she developed EP, which improved after the discontinuation of anti-cancer treatment and the administration of prednisolone. However, EP occurred again upon the reintroduction of endocrine therapy (i.e., letrozole and goserelin). It improved gradually with the suspension of endocrine therapy and the re-administration of prednisolone. This case underscores the need for further research into the prevention and management of EP in patients receiving abemaciclib with endocrine therapy for advanced breast cancer.
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Affiliation(s)
- Hiroaki Ogata
- Department of Respiratory MedicineNHO Fukuoka National HospitalFukuokaJapan
| | - Chinami Koga
- Department of Breast OncologyNHO Kyushu Cancer CenterFukuokaJapan
| | - Toyoshi Yanagihara
- Department of Respiratory MedicineNHO Fukuoka National HospitalFukuokaJapan
| | - Yuki Moriuchi
- Department of Respiratory MedicineNHO Fukuoka National HospitalFukuokaJapan
| | - Aimi Enokizu‐Ogawa
- Department of Respiratory MedicineNHO Fukuoka National HospitalFukuokaJapan
| | - Akiko Ishimatsu
- Department of Respiratory MedicineNHO Fukuoka National HospitalFukuokaJapan
| | - Junji Otsuka
- Department of Respiratory MedicineNHO Fukuoka National HospitalFukuokaJapan
| | - Kazuhito Taguchi
- Department of Respiratory MedicineNHO Fukuoka National HospitalFukuokaJapan
| | - Atsushi Moriwaki
- Department of Respiratory MedicineNHO Fukuoka National HospitalFukuokaJapan
| | - Eriko Tokunaga
- Department of Breast OncologyNHO Kyushu Cancer CenterFukuokaJapan
| | - Makoto Yoshida
- Department of Respiratory MedicineNHO Fukuoka National HospitalFukuokaJapan
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Ayala Torres JD, Noreña B, Suarez Poveda AT. Eosinophilic Pneumonia Induced by Daptomycin. Cureus 2024; 16:e55095. [PMID: 38558746 PMCID: PMC10978459 DOI: 10.7759/cureus.55095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
Daptomycin-induced eosinophilic pneumonia (DIEP) is a rare but serious complication associated with the use of this broad-spectrum antibiotic. We present the case of a teenager with a history of nasopharyngeal cancer who developed DIEP while receiving daptomycin to treat an infection associated with an implanted chamber catheter. Symptoms included recurrent dyspnea and peripheral eosinophilia, with radiological findings consistent with DIEP. The pathophysiology involves an immune response triggered by daptomycin, resulting in eosinophilic pulmonary inflammation. Diagnosis requires a thorough evaluation of medical history, clinical laboratory tests, and radiological findings. The main treatment involves discontinuation of daptomycin and, in severe cases, the use of steroids. It is essential to consider DIEP in patients with respiratory failure and bilateral pulmonary opacities who have used daptomycin and to suspect it in those with blood eosinophilia or in bronchoalveolar lavage.
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Affiliation(s)
| | - Brian Noreña
- Radiology, Universidad de Antioquia, Medellín, COL
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8
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Zhou X, Yang G, Zeng X, Wang L, Xiang J, Zhao J, Chen X, Zhang L. Dupilumab and the potential risk of eosinophilic pneumonia: case report, literature review, and FAERS database analysis. Front Immunol 2024; 14:1277734. [PMID: 38259470 PMCID: PMC10801202 DOI: 10.3389/fimmu.2023.1277734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Eosinophilic pneumonia (EP) is a rare but noteworthy adverse effect linked to dupilumab, an interleukin-4 (IL-4) and IL-13 inhibitor used in the managing atopic diseases. The underlying mechanisms, potential predisposing factors, clinical characteristics, and optimal management strategies for dupilumab-induced EP remain unclear. We report a 71-year-old patient who developed acute EP after the first 600-mg dose of dupilumab. Eosinophils (EOSs) were also transiently increased (up to 1,600 cells/μl). After the acute EP was effectively treated with glucocorticoids, dupilumab treatment was continued. Rash, itching, and immunoglobulin E levels continued to decrease in the patient, and no further pulmonary adverse events occurred. We combined this case with a literature review of nine articles and analyzed data from 93 cases reported in the FDA Adverse Event Reporting System (FAERS) database of patients developing EP after dupilumab use. Our findings imply that dupilumab may induce EP, particularly in individuals over 45 years old, those with a history of respiratory diseases, and those who have previously used inhaled or systemic steroids. Vigilance is required, especially when there is a persistent elevation in peripheral blood EOSs during treatment. Although steroid treatment can effectively manage EP, more data are needed to determine the safety of resuming dupilumab treatment after controlling pneumonia.
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Affiliation(s)
- Xiyuan Zhou
- Institute of Dermatology and Venereology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Ge Yang
- Institute of Dermatology and Venereology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Xuemei Zeng
- Respiratory Department, Chengfei Hospital, Chengdu, China
| | - Lan Wang
- Operation and Management Department, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Jing Xiang
- Outpaitent Department, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Jinyu Zhao
- Education and Training Department, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Xuejun Chen
- Institute of Dermatology and Venereology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Lixia Zhang
- Institute of Dermatology and Venereology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology, Chengdu, China
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9
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Harrison M, Kavanagh G, Corte TJ, Troy LK. Drug-induced interstitial lung disease: a narrative review of a clinical conundrum. Expert Rev Respir Med 2024; 18:23-39. [PMID: 38501199 DOI: 10.1080/17476348.2024.2329612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 03/08/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Drug-induced interstitial lung disease (DI-ILD) is increasing in incidence, due to the use of many new drugs across a broad range of cancers and chronic inflammatory diseases. The presentation and onset of DI-ILD are variable even for the same drug across different individuals. Clinical suspicion is essential for identifying these conditions, with timely drug cessation an important determinant of outcomes. AREAS COVERED This review provides a comprehensive and up-to-date summary of epidemiology, risk factors, pathogenesis, diagnosis, treatment, and prognosis of DI-ILD. Relevant research articles from PubMed and Medline searches up to September 2023 were screened and summarized. Specific drugs including immune checkpoint inhibitors, CAR-T cell therapy, methotrexate, and amiodarone are discussed in detail. The potential role of pharmacogenomic profiling for lung toxicity risk is considered. EXPERT OPINION DI-ILD is likely to be an increasingly important contributor to respiratory disability in the community. These conditions can negatively impact quality of life and patient longevity, due to associated respiratory compromise as well as cessation of evidence-based therapy for the underlying disease. This clinical conundrum is relevant to all areas of medicine, necessitating increased understanding and greater vigilance for drug-related lung toxicity.
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Affiliation(s)
- Megan Harrison
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Grace Kavanagh
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Tamera J Corte
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Lauren K Troy
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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10
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Alghamdi D, Jahdali H, Alharbi A, Alshehri A, Alfirm B, Bamefleh H. Methylphenidate causes chronic eosinophilic pneumonia. Ann Thorac Med 2024; 19:112-115. [PMID: 38444994 PMCID: PMC10911238 DOI: 10.4103/atm.atm_260_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/29/2023] [Indexed: 03/07/2024] Open
Abstract
A man who is 38 years old and diagnosed with attention-deficit hyperactivity disorder was prescribed methylphenidate. Three weeks later, he began experiencing progressive shortness of breath and coughing. Imaging of his chest showed patchy bilateral ground-glass opacities, and bronchoscopy revealed a 15% eosinophil count in his bronchoalveolar lavage. A transbronchial biopsy confirmed a diagnosis of eosinophilic pneumonia. The patient's condition improved when he was given steroids and stopped taking methylphenidate. However, he developed the same symptoms again a few days after restarting the medication, along with a skin rash. This strongly suggests that methylphenidate was the cause of his eosinophilic pneumonia.
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Affiliation(s)
- Dhafer Alghamdi
- Department of Pulmonology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hamdan Jahdali
- Department of Pulmonology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alharbi
- Department of Pulmonology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ahmad Alshehri
- Department of Psychiatry, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Bandar Alfirm
- Department of Psychiatry, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hanaa Bamefleh
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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11
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Okada N, Niimura T, Saisyo A, Kawaguchi Y, Ishizawa K, Kitahara T. Pharmacovigilance Study on Eosinophilic Pneumonia Induced by Anti-MRSA Agents: Analysis Based on the FDA Adverse Event Reporting System. Open Forum Infect Dis 2023; 10:ofad414. [PMID: 37601729 PMCID: PMC10438871 DOI: 10.1093/ofid/ofad414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/30/2023] [Indexed: 08/22/2023] Open
Abstract
Background Eosinophilic pneumonia (EP) is a rare adverse event caused by several types of drugs, such as antibiotics; however, its characteristics remain poorly described. This study aimed to analyze the disproportionality between the occurrence of EP and anti-methicillin-resistant Staphylococcus aureus (anti-MRSA) agents and to characterize anti-MRSA agent-induced EP events using the Food and Drug Administration Adverse Event Reporting System (FAERS). Method Disproportionality linking EP and anti-MRSA agents was analyzed through bayesian confidence propagation neural networks of information components and reporting odds ratio methodologies. The FAERS data set for the fourth quarter of 2012 to the fourth quarter of 2022 was used. We also analyzed the characteristics of EP induced by anti-MRSA agents. Results A total of 14 805 795 reports were obtained from FAERS. Disproportionality analysis revealed that the EP signal was detected only in cases with the administration of daptomycin (DAP). This disproportionality signal was consistently detected in the sensitivity analysis. When compared with other reports of DAP-related adverse events, the reports of DAP-related EP were characterized by male sex (odds ratio [OR], 1.94; 95% CI, 1.12-3.37), older age (>70 years; OR, 2.70; 95% CI, 1.68-4.33), and longer duration of treatment (>21 days; OR, 5.08; 95% CI, 3.21-8.05). Conclusions This study revealed that among the anti-MRSA agents, disproportionality in the occurrence of EP was observed only with DAP. Our results suggest that sex, age, and treatment duration may affect the occurrence of DAP-induced EP. Clinicians should exercise caution regarding EP during DAP administration.
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Affiliation(s)
- Naoto Okada
- Pharmacy Department, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Takahiro Niimura
- Clinical Research Center for Developmental Therapeutics, Tokushima University Hospital, Tokushima, Japan
| | - Atsuyuki Saisyo
- Pharmacy Department, Yamaguchi University Hospital, Yamaguchi, Japan
| | | | - Keisuke Ishizawa
- Clinical Research Center for Developmental Therapeutics, Tokushima University Hospital, Tokushima, Japan
- Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan
- Department of Clinical Pharmacology and Therapeutics, Graduate School of Biomedical Sciences, Tokushima University,Tokushima, Japan
| | - Takashi Kitahara
- Pharmacy Department, Yamaguchi University Hospital, Yamaguchi, Japan
- Clinical Pharmacology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
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12
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Arcalas CJ, Artola R, Hanna ME, Li H, Levy S, Kalyatanda GS. An Unexpected Turn of Events in a Patient With Mitral Valve Endocarditis. Cureus 2023; 15:e42121. [PMID: 37602086 PMCID: PMC10436997 DOI: 10.7759/cureus.42121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
A variety of gram-positive infections can be treated with daptomycin. Daptomycin-induced acute eosinophilic pneumonia (DEP) is a rare adverse drug reaction with nonspecific clinical findings of dyspnea, dry cough, and fever. Although diagnostic criteria exist, prompt recognition is important to prevent rapid progression and respiratory failure. In this case, a 69-year-old female was initially admitted due to a prosthetic joint infection; however, her case was complicated by DEP.
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Affiliation(s)
| | - Richard Artola
- College of Medicine, University of Florida, Gainesville, USA
| | - Megan E Hanna
- Internal Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Han Li
- College of Medicine, University of Florida, Gainesville, USA
| | - Sydney Levy
- College of Medicine, University of Florida, Gainesville, USA
| | - Gautam S Kalyatanda
- Infectious Diseases and Global Medicine, University of Florida College of Medicine, Gainesville, USA
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13
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Zou J, Rivera Sarti JE, Strasfeld L. Daptomycin-associated pulmonary toxicity sans eosinophilia in a hematopoietic cell transplant recipient with profound leukopenia. Transpl Infect Dis 2023; 25:e14029. [PMID: 36787236 DOI: 10.1111/tid.14029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/08/2023] [Indexed: 02/15/2023]
Affiliation(s)
- James Zou
- Division of Infectious Diseases, Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - Jose Eduardo Rivera Sarti
- Division of Infectious Diseases, Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - Lynne Strasfeld
- Division of Infectious Diseases, Oregon Health and Science University School of Medicine, Portland, Oregon, USA
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14
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Engel H, Cudia A, Rimachi R, Schmitz L, Gerain J, De Backer D, Cogan E, David C. [Febrile dyspnea in a 20 year-old woman]. Rev Med Interne 2023:S0248-8663(23)00562-3. [PMID: 37156694 DOI: 10.1016/j.revmed.2023.04.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 04/23/2023] [Indexed: 05/10/2023]
Affiliation(s)
- H Engel
- Service des Soins Intensifs, Hôpital DELTA (CHIREC), Bruxelles, Belgique
| | - A Cudia
- Service des Soins Intensifs, Hôpital DELTA (CHIREC), Bruxelles, Belgique
| | - R Rimachi
- Service des Soins Intensifs, Hôpital DELTA (CHIREC), Bruxelles, Belgique
| | - L Schmitz
- Service des Soins Intensifs, Hôpital DELTA (CHIREC), Bruxelles, Belgique
| | - J Gerain
- Département de Médecine Interne, Hôpital DELTA (CHIREC), Bruxelles, Belgique
| | - D De Backer
- Service des Soins Intensifs, Hôpital DELTA (CHIREC), Bruxelles, Belgique; Université Libre de Bruxelles (ULB), Bruxelles, Belgique
| | - E Cogan
- Département de Médecine Interne, Hôpital DELTA (CHIREC), Bruxelles, Belgique; Université Libre de Bruxelles (ULB), Bruxelles, Belgique.
| | - C David
- Laboratoire de Neurogénétique et Neuroinflammation, Institut Imagine, 24, boulevard du Montparnasse, 75015 Paris, France
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15
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Patel YI, Natarajan S, Ramakrishna S, Ochieng P. Daptomycin-Induced Pulmonary Toxicity: A Case Series. Cureus 2023; 15:e39613. [PMID: 37384075 PMCID: PMC10299848 DOI: 10.7759/cureus.39613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 06/30/2023] Open
Abstract
Daptomycin is a bactericidal antibiotic used to treat methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE). Eosinophilic pneumonia is an uncommon but significant adverse effect of daptomycin. We present two patients treated with daptomycin who subsequently developed eosinophilic pneumonia (EP).
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Affiliation(s)
- Yamini I Patel
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Sarasija Natarajan
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | | | - Pius Ochieng
- Pulmonary and Critical Care Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA
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16
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Vishwanath N, Rhee B, Sobti N, Beqiri D, Xi K, Lerner J, Woo AS. The Role of Antibiotics in Nasal Fractures after Closed Reduction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4886. [PMID: 37038410 PMCID: PMC10082294 DOI: 10.1097/gox.0000000000004886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/17/2023] [Indexed: 04/12/2023]
Abstract
Nasal fractures represent the most common fracture in facial trauma. The role of prophylactic antibiotics in these injuries is debated, given low infection rates and demonstrated risks of antibiotics. We studied the isolated effect of prophylactic antibiotics on infection rate in patients with nasal fracture after closed reduction. Methods Retrospective cohort study of a prospectively maintained facial trauma database was conducted. Demographics, comorbidities, fracture classifications, and management of patients who received antibiotics at the time of closed nasal reduction were compared against those who did not receive antibiotics. Infection rates between groups were analyzed. Multivariate analysis was conducted to control for confounding variables. Qualitative analysis was performed for patients who experienced infection following nasal fracture. Results A total of 282 patients met inclusion criteria (n = 144, antibiotic; n = 138, nonantibiotic). Six patients experienced infection. There was no difference in infection rate between antibiotic and nonantibiotic groups (2.0% versus 2.2%; P = 0.90). On multivariate regression, antibiotics did not significantly decrease odds of infection (OR 1.7 [0.17-13.6]; P = 0.64). Moreover, patients with open nasal fractures did not have significantly higher odds of infection (OR 1.9 [0.08-20.8]; P = 0.64). Similarly, increasing severity of injury based on Rohrich classification did not significantly impact odds of infection (OR 0.68 [0.23-1.9]; P = 0.46). All six infections were managed at the bedside, with zero infections following operating room management (P = 0.32). Conclusions Prophylactic antibiotics do not decrease infection rates following nasal fractures managed by closed reduction. Bedside management may be a risk factor for the development of infection; however, this finding requires further evaluation.
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Affiliation(s)
- Neel Vishwanath
- From the Department of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, R.I
| | - Ben Rhee
- From the Department of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, R.I
| | - Nikhil Sobti
- From the Department of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, R.I
| | - Dardan Beqiri
- From the Department of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, R.I
| | - Kevin Xi
- Brown University School of Public Health, Providence, R.I
| | - Julia Lerner
- From the Department of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, R.I
| | - Albert S Woo
- From the Department of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, R.I
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17
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Sharma S, Rojas H, Spano C, George-Varghese B, Liu T. Acute Eosinophilic Pneumonia Presenting as Altered Mental Status. J Emerg Med 2023; 64:502-505. [PMID: 37002159 DOI: 10.1016/j.jemermed.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/08/2023] [Accepted: 02/17/2023] [Indexed: 03/31/2023]
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18
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Alarcon-Calderon A, Vassallo R, Yi ES, Ryu JH. Smoking-Related Interstitial Lung Diseases. Immunol Allergy Clin North Am 2023; 43:273-287. [PMID: 37055089 DOI: 10.1016/j.iac.2023.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Smoking-related interstitial lung diseases (ILDs) are a group of heterogeneous, diffuse pulmonary parenchymal disease processes associated with tobacco exposure. These disorders include pulmonary Langerhans cell histiocytosis, respiratory bronchiolitis-associated ILD, desquamative interstitial pneumonia, acute eosinophilic pneumonia, and combined pulmonary fibrosis and emphysema. This review summarizes the current evidence of pathogenesis, clinical manifestations, diagnostic approach, prognosis, and treatment modalities for these diseases. We also discuss the interstitial lung abnormalities incidentally detected in radiologic studies and smoking-related fibrosis identified on lung biopsies.
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Affiliation(s)
- Amarilys Alarcon-Calderon
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, 200 1st Street, Southwest, Rochester, MN 55905, USA
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, 200 1st Street, Southwest, Rochester, MN 55905, USA
| | - Eunhee S Yi
- Department of Laboratory Medicine & Pathology, Mayo Clinic College of Medicine and Science, 200 1st Street, Southwest, Rochester, MN 55905, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, 200 1st Street, Southwest, Rochester, MN 55905, USA.
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19
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Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Focus on the Pathophysiological and Diagnostic Role of Viruses. Microorganisms 2023; 11:microorganisms11020346. [PMID: 36838310 PMCID: PMC9966117 DOI: 10.3390/microorganisms11020346] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/31/2023] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a heterogeneous, multiorgan and potentially life-threatening drug-hypersensitivity reaction (DHR) that occurs several days or weeks after drug initiation or discontinuation. DHRs constitute an emerging issue for public health, due to population aging, growing multi-organ morbidity, and subsequent enhanced drug prescriptions. DRESS has more consistently been associated with anticonvulsants, allopurinol and antibiotics, such as sulphonamides and vancomycin, although new drugs are increasingly reported as culprit agents. Reactivation of latent infectious agents such as viruses (especially Herpesviridae) plays a key role in prompting and sustaining aberrant T-cell and eosinophil responses to drugs and pathogens, ultimately causing organ damage. However, the boundaries of the impact of viral agents in the pathophysiology of DRESS are still ill-defined. Along with growing awareness of the multifaceted aspects of immune perturbation caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the ongoing SARS-CoV-2-related disease (COVID-19) pandemic, novel interest has been sparked towards DRESS and the potential interactions among antiviral and anti-drug inflammatory responses. In this review, we summarised the most recent evidence on pathophysiological mechanisms, diagnostic approaches, and clinical management of DRESS with the aim of increasing awareness on this syndrome and possibly suggesting clues for future research in this field.
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20
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Wu C, Li Z, Wang C, Deng Z. Clinical characteristics, management, and outcome of eosinophilic pneumonia associated with daptomycin. Med Clin (Barc) 2023; 160:17-22. [PMID: 35840367 DOI: 10.1016/j.medcli.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/22/2022] [Accepted: 03/29/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The association between daptomycin exposure and eosinophilic pneumonia (EP) is mainly based on case reports. The purpose of this study was to evaluate the clinical characteristics and provide more evidence for better identify and management of daptomycin-induced eosinophilic pneumonia in clinical practice. METHODS Literature from 1991 to October 31, 2021 on EP induced by daptomycin were collected for retrospective analysis. RESULTS A total of 47 patients (40 male and 7 female) from 35 studies were included. The median age was 67 years (range 28-89), and 78.7% of patients were ≥60 years. Daptomycin was mainly used in patients undergoing osteoarticular infections (63.8%). Typical initial symptoms were fever (91.5%), cough (55.3%) and dyspnea (59.6%). The median onset time of symptom was 3 weeks. EP recurred in 14.9% of patients after the re-administration of daptomycin, and 57.1% of EP recurred within 24h. Most cases were accompanied by marked accumulation of eosinophils in peripheral (41 cases) and/or bronchoalveolar lavage fluid (27 cases). The main radiological features were pulmonary infiltration, ground glass opacity or consolidation in CT/CXR. All patients had symptom resolution after discontinuation of daptomycin except for one patient died due to the progression of the primary disease, the median time to symptoms relief was 3 days. Corticosteroids have been shown to help symptoms relief in some cases (59.6%). CONCLUSION Daptomycin-induced eosinophilic pneumonia is a rare and serious complication. Physicians should consider eosinophilic pneumonia as a differential diagnosis when receiving daptomycin therapy, particularly in elderly male patients.
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Affiliation(s)
- Cuifang Wu
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Zuojun Li
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Chunjiang Wang
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Zhenzhen Deng
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China.
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21
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Pham TT, Garreau R, Craighero F, Cottin V, Said BB, Goutelle S, Ferry T. Seventeen Cases of Daptomycin-Induced Eosinophilic Pneumonia in a Cohort of Patients Treated for Bone and Joint Infections: Proposal for a New Algorithm. Open Forum Infect Dis 2022; 9:ofac577. [PMID: 36447615 PMCID: PMC9697587 DOI: 10.1093/ofid/ofac577] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/31/2022] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Daptomycin is increasingly used in the treatment of bone and joint infections (BJIs) and may be responsible for daptomycin-induced eosinophilic pneumonia (DIEP), a potentially severe adverse drug reaction. The aim of this study was to describe DIEP in patients treated at a referral center for the management of BJI, and to revisit current definitions of this disease. METHODS Patients treated from 1 January 2012 to 31 March 2021 were included in a prospective cohort (NCT02817711), in which all potential serious adverse events are prospectively recorded. Patients diagnosed with DIEP were retrospectively analyzed using different definitions. RESULTS In a total of 4664 patients included in the cohort during the study period, 1021 patients (21.9%) received daptomycin, of whom 17 (1.7%) were diagnosed with DIEP. Most patients were male (n = 11 [64.7%]), and periprosthetic joint infection was the commonest BJI (n = 12 [70.6%]). Only 1 patient had bronchoalveolar lavage (BAL) eosinophil count ≥25%, while most patients had peripheral blood eosinophilia (n = 15 [88.2%]). Chest computed tomography (CT) was compatible with eosinophilic pneumonia in 13 of 14 cases (92.9%). All patients recovered upon discontinuation of daptomycin. Using the different definitions available, only a minority of cases fulfilled existing criteria for DIEP. We propose a new algorithm that includes specific CT scan signs, and systemic instead of BAL eosinophilia. CONCLUSIONS DIEP is a rare event that requires prompt discontinuation of the causative antibiotic. Current criteria to diagnose definite DIEP are too restrictive and not easily applicable in clinical practice. A new algorithm is proposed here (Lyon algorithm) to facilitate the early identification of DIEP.
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Affiliation(s)
- Truong-Thanh Pham
- Correspondence: Truong-Thanh Pham, MD, Division of Infectious Diseases, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland ()
| | - Romain Garreau
- Pharmacy Department, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon, Unités mixtes de recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 5558, Villeurbanne, France
| | - Fabien Craighero
- French Referral Centre for Complex Bone and Joint Infections, Lyon, France
- Radiology Department, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
- Claude Bernard University Lyon 1, University of Lyon, Institut national de recherche pour l'agriculture, l'alimentation et l'environnement (INRAE), Infections Virales et Pathologie Comparée, Unités mixtes de recherche (UMR) 754, European Reference Networks on Respiratory Diseases (ENR-LUNG), Lyon, France
| | - Benoît Ben Said
- Severe Cutaneous Adverse Reaction Regional Center and Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Sylvain Goutelle
- Pharmacy Department, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon, Unités mixtes de recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 5558, Villeurbanne, France
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22
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Abd Algayoum R, Elsherif A, Khan ZH, Roman G. Daptomycin-Induced Eosinophilic Pneumonia Mimicking Multifocal Pneumonia. Cureus 2022; 14:e30521. [PMID: 36415446 PMCID: PMC9675429 DOI: 10.7759/cureus.30521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/19/2022] [Indexed: 11/07/2022] Open
Abstract
A 71-year-old female presented to the emergency department with worsening dyspnea, dry cough, malaise, weight loss, fever, chills, and diaphoresis for one week. The patient had been hospitalized four weeks prior with right knee methicillin-resistant Staphylococcus aureus (MRSA) bursitis and was initially treated with IV vancomycin but was switched to IV daptomycin at the time of discharge for convenience of dosing. On presentation to the ED, vitals were normal. Physical examination revealed bilateral scattered rhonchi and crepitations. Chest X-ray revealed new patchy bilateral interstitial and airspace opacities concerning for multifocal pneumonia. Labs were pertinent for mild peripheral eosinophilia. CT chest revealed moderate diffuse ground glass opacities involving both lungs, with subpleural predominance and some areas of septal thickening seen as well. Daptomycin-induced pneumonitis was suspected, and empiric antibiotics were discontinued. The patient subsequently underwent fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial lung biopsy. BAL fluid showed leukocytosis and eosinophilia of 25 mm3. Right upper lobe biopsy demonstrated foci of alveolar spaces with collections of eosinophils and histiocytes consistent with acute eosinophilic pneumonia. The patient was started on oral prednisone and albuterol breathing treatments with significant improvement after 48 hours from admission. She was discharged on albuterol inhalers and prednisone taper. Acute eosinophilic pneumonia (AEP) is a lung condition that can be rapidly progressive, leading to significant morbidity and mortality. Daptomycin-induced AEP can mimic community-acquired pneumonia, resulting in delayed diagnosis and management. Recognizing the temporal association between drug initiation and the development of symptoms is crucial in the diagnosis of drug-induced AEP. If it is recognized and treated in a timely manner, the prognosis is generally excellent, with rapid and complete clinical recovery as demonstrated by our case.
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23
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Chmielewski M, VanNostrand J, Hollander M. Fever and Pleuritic Chest Pain in a 16-year-old Girl with Ulcerative Colitis. Pediatr Rev 2022; 43:586-589. [PMID: 36180542 DOI: 10.1542/pir.2021-004937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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24
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Fujii M, Kenzaka T. Drug-induced lung injury caused by acetaminophen in a Japanese woman: A case report. World J Clin Cases 2022; 10:9936-9944. [PMID: 36186171 PMCID: PMC9516906 DOI: 10.12998/wjcc.v10.i27.9936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/02/2022] [Accepted: 08/12/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND All drugs have the potential to cause drug-induced lung injury both during and after drug administration. Acetaminophen has been reported to cause drug-induced lung injury, although this is extremely rare. Herein, we present an extremely rare case of acetaminophen-induced pneumonia.
CASE SUMMARY A healthy 35-year-old Japanese woman visited a neighborhood clinic with complaints of fever and malaise following a tick bite. Her treatment included 1,500 mg acetaminophen (Caronal®) and subsequently minocycline (200 mg) and acetaminophen (2,000 mg; Caronal®) daily when her condition did not improve; the patient was eventually hospitalized. The patient’s chest computed tomography (CT) revealed consolidation and ground-glass opacities in the right middle and lower lobes. Minocycline was shifted to sulbactam/ampicillin. However, her fever did not improve during follow-up, and her chest CT revealed extensive ground-glass opacities in the right middle and lower lobes and thick infiltrative shadows in the bilateral basal areas. Drug-induced lung injury was suspected; hence, acetaminophen was discontinued. The fever resolved immediately, and inflammatory response and respiratory imaging findings improved. A drug-induced lymphocyte stimulation test was performed against acetaminophen (Caronal®), and significant proliferation of lymphocytes was noted only for acetaminophen (stimulation index, 2.1).
CONCLUSION Even common drugs such as over-the-counter drugs can cause drug-induced lung damage.
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Affiliation(s)
- Masayoshi Fujii
- Department of Internal Medicine, Toyooka Public Hospital, Toyooka 668-8501, Japan
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba 669-3495, Japan
| | - Tsuneaki Kenzaka
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba 669-3495, Japan
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe 652-0032, Japan
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25
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An Explainable Supervised Machine Learning Model for Predicting Respiratory Toxicity of Chemicals Using Optimal Molecular Descriptors. Pharmaceutics 2022; 14:pharmaceutics14040832. [PMID: 35456666 PMCID: PMC9028223 DOI: 10.3390/pharmaceutics14040832] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/30/2022] [Accepted: 04/03/2022] [Indexed: 01/27/2023] Open
Abstract
Respiratory toxicity is a serious public health concern caused by the adverse effects of drugs or chemicals, so the pharmaceutical and chemical industries demand reliable and precise computational tools to assess the respiratory toxicity of compounds. The purpose of this study is to develop quantitative structure-activity relationship models for a large dataset of chemical compounds associated with respiratory system toxicity. First, several feature selection techniques are explored to find the optimal subset of molecular descriptors for efficient modeling. Then, eight different machine learning algorithms are utilized to construct respiratory toxicity prediction models. The support vector machine classifier outperforms all other optimized models in 10-fold cross-validation. Additionally, it outperforms the prior study by 2% in prediction accuracy and 4% in MCC. The best SVM model achieves a prediction accuracy of 86.2% and a MCC of 0.722 on the test set. The proposed SVM model predictions are explained using the SHapley Additive exPlanations approach, which prioritizes the relevance of key modeling descriptors influencing the prediction of respiratory toxicity. Thus, our proposed model would be incredibly beneficial in the early stages of drug development for predicting and understanding potential respiratory toxic compounds.
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26
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Zgheib O, Trombert V, Jandus P, Serratrice C. Drug-induced hypersensitivity syndrome with lupus manifestations due to mesalazine in a patient with ulcerative colitis. BMJ Case Rep 2022; 15:e248229. [PMID: 35217557 PMCID: PMC8883224 DOI: 10.1136/bcr-2021-248229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 11/04/2022] Open
Abstract
Mesalazine is often used as first-line therapy for ulcerative colitis. Several reports have pointed to systemic adverse reactions associated with this drug. Most have evoked a drug-induced hypersensitivity syndrome, while some have described lupus syndromes but with limited clinical and varied biological features. A 75-year-old man presented with fever, dyspnoea, chest pain, polyarthralgia, and myalgia, following mesalazine introduction. Clinical symptoms and low-titre positive antihistone antibodies disappeared after mesalazine withdrawal without recourse to steroids. Pericardial effusion and 8F-fluorodeoxyglucose uptake on positron emission tomography/CT scan, and glomerular haematuria and proteinuria also disappeared. Cytokine-lymphocyte transformation tests showed a strong sensitisation pattern with interleukin-5 production. This case advances our knowledge of the mechanism of mesalazine-induced adverse effects, namely via drug-induced hypersensitivity with lupus manifestations, which we are the first to report.
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Affiliation(s)
- Omar Zgheib
- Internal Medicine of the Elderly, Geneva University Hospitals, Geneva, Switzerland
| | - Véronique Trombert
- Internal Medicine of the Elderly, Geneva University Hospitals, Geneva, Switzerland
| | - Peter Jandus
- Immunology and Allergology, Geneva University Hospitals, Geneva, Switzerland
| | - Christine Serratrice
- Internal Medicine of the Elderly, Geneva University Hospitals, Geneva, Switzerland
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Mitarai Y, Tsubata Y, Hyakudomi M, Isobe T. Drug-Induced Eosinophilic Pneumonia as an Adverse Event of Abemaciclib. Cureus 2022; 14:e21741. [PMID: 35251813 PMCID: PMC8888010 DOI: 10.7759/cureus.21741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/05/2022] Open
Abstract
In 2020, a 45-year-old woman was started on fulvestrant and abemaciclib therapy to treat breast cancer which had recurred in her left breast after surgery. We were able to control her cancer using this treatment; however, the ground-glass opacity in the lower lobe of her right lung expanded, along with an increase in her peripheral blood eosinophil count. She was referred to the respiratory medicine department for a detailed examination including bronchoscopy. We discovered a high proportion of eosinophils in her bronchoalveolar lavage fluid and diagnosed the condition as drug-induced eosinophilic pneumonia. The ground-glass change improved after steroid administration. In this case, the adverse effects of abemaciclib, a cyclin-dependent kinase 4/6 inhibitor playing an essential role in breast cancer treatment, were discovered by combining blood, imaging, and bronchoalveolar lavage fluid findings. This contributed to an early introduction of treatment and prevented the deterioration of her quality of life.
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Sridhar S, Kanne JP, Henry TS, Revels JW, Gotway MB, Ketai LH. Medication-induced Pulmonary Injury: A Scenario- and Pattern-based Approach to a Perplexing Problem. Radiographics 2021; 42:38-55. [PMID: 34826256 DOI: 10.1148/rg.210146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Medication-induced pulmonary injury (MIPI) is a complex medical condition that has become increasingly common yet remains stubbornly difficult to diagnose. Diagnosis can be aided by combining knowledge of the most common imaging patterns caused by MIPI with awareness of which medications a patient may be exposed to in specific clinical settings. The authors describe six imaging patterns commonly associated with MIPI: sarcoidosis-like, diffuse ground-glass opacities, organizing pneumonia, centrilobular ground-glass nodules, linear-septal, and fibrotic. Subsequently, the occurrence of these patterns is discussed in the context of five different clinical scenarios and the medications and medication classes typically used in those scenarios. These scenarios and medication classes include the rheumatology or gastrointestinal clinic (disease-modifying antirheumatic agents), cardiology clinic (antiarrhythmics), hematology clinic (cytotoxic agents, tyrosine kinase inhibitors, retinoids), oncology clinic (immune modulators, tyrosine kinase inhibitors, monoclonal antibodies), and inpatient service (antibiotics, blood products). Additionally, the article draws comparisons between the appearance of MIPI and the alternative causes of lung disease typically seen in those clinical scenarios (eg, connective tissue disease-related interstitial lung disease in the rheumatology clinic and hydrostatic pulmonary edema in the cardiology clinic). Familiarity with the most common imaging patterns associated with frequently administered medications can help insert MIPI into the differential diagnosis of acquired lung disease in these scenarios. However, confident diagnosis is often thwarted by absence of specific diagnostic tests for MIPI. Instead, a working diagnosis typically relies on multidisciplinary consensus. ©RSNA, 2021.
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Affiliation(s)
- Shravan Sridhar
- From the Department of Radiology, University of California San Francisco, San Francisco, Calif (S.S.); Department of Radiology, University of Wisconsin, Madison, Wis (J.P.K.); Department of Radiology, Duke University, Durham, NC (T.S.H.); Department of Radiology, University of New Mexico, MSC10 5530, 1 University of New Mexico, Albuquerque, NM 87131 (J.W.R., L.H.K.); and Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.B.G.)
| | - Jeffrey P Kanne
- From the Department of Radiology, University of California San Francisco, San Francisco, Calif (S.S.); Department of Radiology, University of Wisconsin, Madison, Wis (J.P.K.); Department of Radiology, Duke University, Durham, NC (T.S.H.); Department of Radiology, University of New Mexico, MSC10 5530, 1 University of New Mexico, Albuquerque, NM 87131 (J.W.R., L.H.K.); and Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.B.G.)
| | - Travis S Henry
- From the Department of Radiology, University of California San Francisco, San Francisco, Calif (S.S.); Department of Radiology, University of Wisconsin, Madison, Wis (J.P.K.); Department of Radiology, Duke University, Durham, NC (T.S.H.); Department of Radiology, University of New Mexico, MSC10 5530, 1 University of New Mexico, Albuquerque, NM 87131 (J.W.R., L.H.K.); and Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.B.G.)
| | - Jonathan W Revels
- From the Department of Radiology, University of California San Francisco, San Francisco, Calif (S.S.); Department of Radiology, University of Wisconsin, Madison, Wis (J.P.K.); Department of Radiology, Duke University, Durham, NC (T.S.H.); Department of Radiology, University of New Mexico, MSC10 5530, 1 University of New Mexico, Albuquerque, NM 87131 (J.W.R., L.H.K.); and Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.B.G.)
| | - Michael B Gotway
- From the Department of Radiology, University of California San Francisco, San Francisco, Calif (S.S.); Department of Radiology, University of Wisconsin, Madison, Wis (J.P.K.); Department of Radiology, Duke University, Durham, NC (T.S.H.); Department of Radiology, University of New Mexico, MSC10 5530, 1 University of New Mexico, Albuquerque, NM 87131 (J.W.R., L.H.K.); and Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.B.G.)
| | - Loren H Ketai
- From the Department of Radiology, University of California San Francisco, San Francisco, Calif (S.S.); Department of Radiology, University of Wisconsin, Madison, Wis (J.P.K.); Department of Radiology, Duke University, Durham, NC (T.S.H.); Department of Radiology, University of New Mexico, MSC10 5530, 1 University of New Mexico, Albuquerque, NM 87131 (J.W.R., L.H.K.); and Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.B.G.)
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Kadyrova A, Antipina I, Kyrbasheva I, Baudinov I, Kulbaeva B, Aitieva U, Zhunushaliev C, Vityala Y, Tagaev T. CT patterns and differential criteria for acute eosinophilic pneumonia and COVID-19 pneumonia. Clin Case Rep 2021; 9:e04890. [PMID: 34631074 PMCID: PMC8489509 DOI: 10.1002/ccr3.4890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/11/2021] [Accepted: 09/12/2021] [Indexed: 11/18/2022] Open
Abstract
Difficulties encountered in diagnosing and treating COVID-19 pneumonia and acute eosinophilic pneumonia during the pandemic from 2019 to 2021 led to the identification and study of the differential features of the two conditions.
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Affiliation(s)
- Aliya Kadyrova
- Department of Radiology I.K. Akhunbaev Kyrgyz State Medical Academy Bishkek Kyrgyzstan
| | - Irina Antipina
- Department of Radiology I.K. Akhunbaev Kyrgyz State Medical Academy Bishkek Kyrgyzstan
| | - Indira Kyrbasheva
- Department of Radiology I.K. Akhunbaev Kyrgyz State Medical Academy Bishkek Kyrgyzstan
| | - Iliar Baudinov
- Department of Radiology I.K. Akhunbaev Kyrgyz State Medical Academy Bishkek Kyrgyzstan
| | - Begaim Kulbaeva
- Department of Radiology I.K. Akhunbaev Kyrgyz State Medical Academy Bishkek Kyrgyzstan
| | - Uuljan Aitieva
- Department of Radiology I.K. Akhunbaev Kyrgyz State Medical Academy Bishkek Kyrgyzstan
| | | | - Yethindra Vityala
- Department of Pathology International Higher School of Medicine International University of Kyrgyzstan Bishkek Kyrgyzstan
| | - Tugolbai Tagaev
- Department of Hospital Internal Medicine Occupational Pathology with a Course of Hematology I.K. Akhunbaev Kyrgyz State Medical Academy Bishkek Kyrgyzstan
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30
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Kaninia S, Edey AJ, Maskell NA, Rice CM. Natalizumab-induced pneumonitis. J Neurol 2021; 269:1688-1690. [PMID: 34550470 PMCID: PMC8456190 DOI: 10.1007/s00415-021-10811-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Stefania Kaninia
- Department of Neurology, North Bristol NHS Trust, Bristol, UK.,Bristol Medical School, University of Bristol, Bristol, UK
| | - Anthony J Edey
- Department of Radiology, North Bristol NHS Trust, Bristol, UK
| | - Nick A Maskell
- Bristol Medical School, University of Bristol, Bristol, UK.,Department of Respiratory Medicine, North Bristol NHS Trust, Bristol, UK
| | - Claire M Rice
- Department of Neurology, North Bristol NHS Trust, Bristol, UK. .,Bristol Medical School, University of Bristol, Bristol, UK.
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31
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Dulaney D, Dave P, Walsh S, Mehandru S, Colombel JF, Agrawal M. Noninfectious Pulmonary Complications Associated With Anti-Integrin Therapy: A Case Report and Systematic Review of the Literature. Inflamm Bowel Dis 2021; 28:479-483. [PMID: 34427639 PMCID: PMC9122753 DOI: 10.1093/ibd/izab212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Indexed: 12/24/2022]
Affiliation(s)
- David Dulaney
- Department of Gastroenterology and Hepatology, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Priya Dave
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samantha Walsh
- Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Saurabh Mehandru
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jean-Frederic Colombel
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Manasi Agrawal
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Address correspondence to: Manasi Agrawal, The Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York NY 10029 ()
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32
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Colbenson GA, Olson EM, Nelson DR. 61-Year-Old Man With Shortness of Breath and Cough. Mayo Clin Proc 2021; 96:2243-2247. [PMID: 34226026 DOI: 10.1016/j.mayocp.2020.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 10/20/2022]
Affiliation(s)
- Gretchen A Colbenson
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Emily M Olson
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Darlene R Nelson
- Advisor to residents and Consultant in Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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34
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Martins AM, Marto JM, Johnson JL, Graber EM. A Review of Systemic Minocycline Side Effects and Topical Minocycline as a Safer Alternative for Treating Acne and Rosacea. Antibiotics (Basel) 2021; 10:antibiotics10070757. [PMID: 34206485 PMCID: PMC8300648 DOI: 10.3390/antibiotics10070757] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 01/03/2023] Open
Abstract
Resistance of Cutibacterium acnes to topical antibiotics historically used to treat acne (topical erythromycin and clindamycin and, more recently, topical azithromycin and clarithromycin) has been steadily increasing and new topical antibiotics are needed. Minocycline is a semisynthetic tetracycline-derived antibiotic currently used systemically to treat a wide range of infections caused by Gram-negative and Gram-positive bacteria. In addition to its antibiotic activity, minocycline possesses anti-inflammatory properties, such as the downregulation of proinflammatory cytokine production, suppression of neutrophil chemotaxis, activation of superoxide dismutase, and inhibition of phagocytosis, among others. These characteristics make minocycline a valuable agent for treatment of dermatological diseases such as acne vulgaris and papulopustular rosacea. However, more frequent or serious adverse effects have been observed upon the systemic administration of minocycline than with other tetracyclines. Examples of serious adverse effects include hypersensitivity syndrome reaction, drug-induced lupus, idiopathic intracranial hypertension, and other autoimmune syndromes that may cause death. Here, we review adverse effects and drug–drug interactions observed with oral administration of minocycline and contrast this with topical minocycline formulations recently approved or under development for effectively treating dermatological disorders with fewer adverse effects and less drug interaction.
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Affiliation(s)
- Ana M. Martins
- Research Institute for Medicine (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal; (A.M.M.); (J.M.M.)
| | - Joana M. Marto
- Research Institute for Medicine (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal; (A.M.M.); (J.M.M.)
| | - Jodi L. Johnson
- Departments of Pathology and Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
| | - Emmy M. Graber
- The Dermatology Institute, Boston, MA 02116, USA
- Northeastern University, Boston, MA 02115, USA
- Correspondence: ; Tel.: +1-857-317-2057
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Harne PS, Rao S, Malik M, Shepherd Z. Acute Eosinophilic Pneumonia Secondary to Menthol Cigarette Use: A Rare Phenomenon With a Review of Literature. J Investig Med High Impact Case Rep 2021; 8:2324709620925978. [PMID: 32462944 PMCID: PMC7262976 DOI: 10.1177/2324709620925978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Idiopathic acute eosinophilic pneumonia (AEP) is a very rare disease with fewer than 200 cases reported. It has been hypothesized to be a hypersensitivity reaction to an unidentified antigen. The clinical presentation typically involves fever, nonproductive cough, shortness of breath, and bibasilar inspiratory crackles within the first week of antigen exposure. Chest imaging usually reveals bilateral reticular and/or ground-glass opacities. Bronchoalveolar lavage demonstrates >25% eosinophils. Corticosteroids are the mainstay of treatment with good results; however, optimum dose and length of treatment are unclear. We present a case of a 31-year-old male who presented with 2 days of shortness of breath, cough, pleuritic chest pain, fevers, chills, nausea, and poor appetite in the setting of initiation of menthol-flavored cigarettes 2 weeks before presentation. He rapidly progressed to respiratory failure requiring intubation despite broad antibiotic coverage. His course was complicated by severe acute respiratory distress syndrome, circulatory shock, and renal failure. He underwent bronchoalveolar lavage testing that revealed 60% eosinophils. He was treated with steroids and was subsequently extubated and discharged. Eosinophilic counts in the blood peaked on the 10th day of admission to 34%. One week later, the patient was completely free of symptoms. The initiation of menthol cigarette use in this patient is the likely reason for ensuing acute eosinophilic pneumonia, hence adding to the sporadic reports on the role of menthol-flavored cigarettes. This case emphasizes a greater reliance on risk factors, as opposed to eosinophilic markers, for the diagnosis and treatment of acute eosinophilic pneumonia to prevent subsequent respiratory failure and intubation in such patients.
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Affiliation(s)
| | - Suman Rao
- SUNY Upstate Medical University, Syracuse, NY, USA
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Eosinophilic pneumonia caused by cefepime: A case report and review. IDCases 2021; 25:e01166. [PMID: 34094864 PMCID: PMC8167208 DOI: 10.1016/j.idcr.2021.e01166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/18/2021] [Accepted: 05/18/2021] [Indexed: 02/03/2023] Open
Abstract
Eosinophilic pneumonia (EP) is a diagnosis supported by increased blood eosinophils & infiltrates on chest radiographs. We highlight the first known case of EP caused by cefepime in a patient treated for pneumonia. Cefepime is commonly used for a variety of infections in hospitals and EP may be an underreported adverse event.
Eosinophilic pneumonia (EP) is characterized by accumulation of eosinophils in the lungs and has been associated with several medications, including antimicrobials. Cefepime is a commonly used broad-spectrum antimicrobial agent for the treatment of nosocomial infections but to date has not been associated with EP. We report the first documented case of EP secondary to cefepime for the treatment of pneumonia. The patient’s peripheral eosinophilia and leukocytosis resolved promptly after discontinuation of cefepime and initiation of steroid treatment.
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Ahouansou N, Georges M, Beltramo G, Aswad N, Hassani Y, Bonniaud P. Daptomycin-induced eosinophilic pneumonia: Are there any risk factors? Infect Dis Now 2021; 51:618-621. [PMID: 33870898 DOI: 10.1016/j.idnow.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/20/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Daptomycin is a widely used antibiotic. Rhabdomyolysis related to daptomycin is one of the adverse effects of treatment, justifying the need for regular monitoring of muscle enzymes throughout treatment. Daptomycin may also lead to eosinophilic pneumonia. However, risk factors for this adverse reaction have not been identified and do not permit targeting of at-risk populations who could benefit from appropriate monitoring. PATIENTS AND METHODS Literature was reviewed for cases of daptomycin-induced eosinophilic pneumonia (DIEP), which that were compared to cases of patients without this adverse effect. RESULTS Fifty patients with DIEP and 54 controls were identified. Age, sex, and treatment dose are not associated with the occurrence of DIEP. A high dose of daptomycin is not associated with an early onset of DIEP. About one third of patients with eosinophilic lung disease have diabetes or renal impairment. CONCLUSIONS Further studies may help to identify additional factors.
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Affiliation(s)
- Nelly Ahouansou
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence Constitutif des maladies Pulmonaires rares de l'Adultes de Dijon, réseau OrphaLung, Filère RespiFil, Centre Hospitalier Universitaire de Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - Marjolaine Georges
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence Constitutif des maladies Pulmonaires rares de l'Adultes de Dijon, réseau OrphaLung, Filère RespiFil, Centre Hospitalier Universitaire de Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France; Université de Bourgogne Franche-Comté, Faculté de médecine, Dijon, France; NSERM U123-1, Dijon, France.
| | - Guillaume Beltramo
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence Constitutif des maladies Pulmonaires rares de l'Adultes de Dijon, réseau OrphaLung, Filère RespiFil, Centre Hospitalier Universitaire de Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France; Université de Bourgogne Franche-Comté, Faculté de médecine, Dijon, France; NSERM U123-1, Dijon, France
| | - Nicolas Aswad
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence Constitutif des maladies Pulmonaires rares de l'Adultes de Dijon, réseau OrphaLung, Filère RespiFil, Centre Hospitalier Universitaire de Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - Yasmina Hassani
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence Constitutif des maladies Pulmonaires rares de l'Adultes de Dijon, réseau OrphaLung, Filère RespiFil, Centre Hospitalier Universitaire de Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - Philippe Bonniaud
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence Constitutif des maladies Pulmonaires rares de l'Adultes de Dijon, réseau OrphaLung, Filère RespiFil, Centre Hospitalier Universitaire de Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France; Université de Bourgogne Franche-Comté, Faculté de médecine, Dijon, France; NSERM U123-1, Dijon, France
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Soldevila-Boixader L, Villanueva B, Ulldemolins M, Benavent E, Padulles A, Ribera A, Borras I, Ariza J, Murillo O. Risk Factors of Daptomycin-Induced Eosinophilic Pneumonia in a Population with Osteoarticular Infection. Antibiotics (Basel) 2021; 10:446. [PMID: 33923382 PMCID: PMC8071505 DOI: 10.3390/antibiotics10040446] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Daptomycin-induced eosinophilic pneumonia (DEP) is a rare but severe adverse effect and the risk factors are unknown. The aim of this study was to determine risk factors for DEP. METHODS A retrospective cohort study was performed at the Bone and Joint Infection Unit of the Hospital Universitari Bellvitge (January 2014-December 2018). To identify risk factors for DEP, cases were divided into two groups: those who developed DEP and those without DEP. RESULTS Among the whole cohort (n = 229) we identified 11 DEP cases (4.8%) and this percentage almost doubled in the subgroup of patients ≥70 years (8.1%). The risk factors for DEP were age ≥70 years (HR 10.19, 95%CI 1.28-80.93), therapy >14 days (7.71, 1.98-30.09) and total cumulative dose of daptomycin ≥10 g (5.30, 1.14-24.66). CONCLUSIONS Clinicians should monitor cumulative daptomycin dosage to minimize DEP risk, and be cautious particularly in older patients when the total dose of daptomycin exceeds 10 g.
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Affiliation(s)
- Laura Soldevila-Boixader
- Infectious Diseases Service, IDIBELL-Hospital Universitari Bellvitge, Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.S.-B.); (B.V.); (M.U.); (E.B.); (A.R.); (I.B.); (J.A.)
- Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain
| | - Bernat Villanueva
- Infectious Diseases Service, IDIBELL-Hospital Universitari Bellvitge, Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.S.-B.); (B.V.); (M.U.); (E.B.); (A.R.); (I.B.); (J.A.)
| | - Marta Ulldemolins
- Infectious Diseases Service, IDIBELL-Hospital Universitari Bellvitge, Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.S.-B.); (B.V.); (M.U.); (E.B.); (A.R.); (I.B.); (J.A.)
| | - Eva Benavent
- Infectious Diseases Service, IDIBELL-Hospital Universitari Bellvitge, Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.S.-B.); (B.V.); (M.U.); (E.B.); (A.R.); (I.B.); (J.A.)
- Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain
| | - Ariadna Padulles
- Pharmacy Department, IDIBELL-Hospital Universitari Bellvitge, Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Alba Ribera
- Infectious Diseases Service, IDIBELL-Hospital Universitari Bellvitge, Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.S.-B.); (B.V.); (M.U.); (E.B.); (A.R.); (I.B.); (J.A.)
- Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain
| | - Irene Borras
- Infectious Diseases Service, IDIBELL-Hospital Universitari Bellvitge, Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.S.-B.); (B.V.); (M.U.); (E.B.); (A.R.); (I.B.); (J.A.)
| | - Javier Ariza
- Infectious Diseases Service, IDIBELL-Hospital Universitari Bellvitge, Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.S.-B.); (B.V.); (M.U.); (E.B.); (A.R.); (I.B.); (J.A.)
- Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Oscar Murillo
- Infectious Diseases Service, IDIBELL-Hospital Universitari Bellvitge, Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.S.-B.); (B.V.); (M.U.); (E.B.); (A.R.); (I.B.); (J.A.)
- Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, 28029 Madrid, Spain
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John TM, Kontoyiannis DP. Do Not Forget Daptomycin as a Cause of Eosinophilic Pneumonia! Chest 2021; 159:1687-1688. [PMID: 34022008 DOI: 10.1016/j.chest.2020.10.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Teny M John
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX
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Response. Chest 2021; 159:1688. [PMID: 34022010 DOI: 10.1016/j.chest.2020.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 11/20/2022] Open
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Malézieux-Picard A, Ferrer Soler C, De Macedo Ferreira D, Gaud-Luethi E, Serratrice C, Mendes A, Zekry D, Gold G, Lobrinus JA, Arnoux G, Serra F, Prendki V. Undetected Causes of Death in Hospitalized Elderly with COVID-19: Lessons from Autopsy. J Clin Med 2021; 10:jcm10071337. [PMID: 33804890 PMCID: PMC8037274 DOI: 10.3390/jcm10071337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/17/2021] [Accepted: 03/20/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Mechanisms and causes of death in older patients with SARS-CoV-2 infection are still poorly understood. Methods: We conducted in a retrospective monocentric study, a clinical chart review and post-mortem examination of patients aged 75 years and older hospitalized in acute care and positive for SARS-CoV-2. Full body autopsy and correlation with clinical findings and suspected causes of death were done. Results: Autopsies were performed in 12 patients (median age 85 years; median of 4 comorbidities, mainly hypertension and cardiovascular disease). All cases showed exudative or proliferative phases of alveolar damage and/or a pattern of organizing pneumonia. Causes of death were concordant in 6 cases (50%), and undetected diagnoses were found in 6. Five patients died from hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19), five had another associated diagnosis and two died from alternative causes. Deaths that occurred in the second week were related to SARS-CoV-2 pneumonia whereas those occurring earlier were related mainly to heart failure and those occurring later to complications. Conclusions: Although COVID-19 hypoxemic respiratory failure was the most common cause of death, post-mortem pathological examination revealed that acute decompensation from chronic comorbidities during the first week of COVID-19 and complications in the third week contributed to mortality.
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Affiliation(s)
- Astrid Malézieux-Picard
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Hôpital des Trois-Chêne, 1226 Thônex-Genève, Switzerland; (D.D.M.F.); (C.S.); (D.Z.); (V.P.)
- Correspondence:
| | - Cecilia Ferrer Soler
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Hôpital des Trois-Chêne, 1226 Thônex-Genève, Switzerland; (C.F.S.); (E.G.-L.); (A.M.); (G.G.)
| | - David De Macedo Ferreira
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Hôpital des Trois-Chêne, 1226 Thônex-Genève, Switzerland; (D.D.M.F.); (C.S.); (D.Z.); (V.P.)
| | - Emilie Gaud-Luethi
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Hôpital des Trois-Chêne, 1226 Thônex-Genève, Switzerland; (C.F.S.); (E.G.-L.); (A.M.); (G.G.)
| | - Christine Serratrice
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Hôpital des Trois-Chêne, 1226 Thônex-Genève, Switzerland; (D.D.M.F.); (C.S.); (D.Z.); (V.P.)
| | - Aline Mendes
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Hôpital des Trois-Chêne, 1226 Thônex-Genève, Switzerland; (C.F.S.); (E.G.-L.); (A.M.); (G.G.)
| | - Dina Zekry
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Hôpital des Trois-Chêne, 1226 Thônex-Genève, Switzerland; (D.D.M.F.); (C.S.); (D.Z.); (V.P.)
| | - Gabriel Gold
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Hôpital des Trois-Chêne, 1226 Thônex-Genève, Switzerland; (C.F.S.); (E.G.-L.); (A.M.); (G.G.)
| | | | - Grégoire Arnoux
- Division of Pathology, University Hospitals of Geneva, 1205 Geneva, Switzerland; (J.A.L.); (G.A.); (F.S.)
| | - Fulvia Serra
- Division of Pathology, University Hospitals of Geneva, 1205 Geneva, Switzerland; (J.A.L.); (G.A.); (F.S.)
| | - Virginie Prendki
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Hôpital des Trois-Chêne, 1226 Thônex-Genève, Switzerland; (D.D.M.F.); (C.S.); (D.Z.); (V.P.)
- Division of Infectious Disease, University Hospitals of Geneva, 1205 Geneva, Switzerland
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Raman V, Chaudhary I, Shieh S. Eosinophilic pneumonia: a case of daptomycin induced lung injury. J Community Hosp Intern Med Perspect 2021; 11:280-285. [PMID: 33889339 PMCID: PMC8043520 DOI: 10.1080/20009666.2021.1883813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Eosinophilic pneumonia is a category of lung diseases characterized by an increased number of eosinophils in alveolar spaces and interstitium. Acute cases are often caused by fungal infections, parasites, drugs or toxins and can present with respiratory failure. Daptomycin has been identified as one of the rare causes of acute eosinophilic pneumonia. We describe a case of an elderly man on daptomycin for MRSA endocarditis treatment who presented to the hospital with fevers and dyspnea within two weeks of daptomycin initiation. As an inpatient, he developed an increasing oxygen requirement necessitating intensive care unit management. Daptomycin cessation improved his symptoms and he was placed on a steroid taper. These findings suggested a diagnosis of daptomycin-induced eosinophilic pneumonia. However, the patient deteriorated and eventually passed away despite resuscitative efforts. This case highlights the importance of prompt identification of eosinophilic pneumonia, its potential severity and the need for more exploration regarding the timing of corticosteroid taper. This in turn will inform more effective approaches to this condition in the future.
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Affiliation(s)
| | - Isha Chaudhary
- Saba University School of Medicine, Saba, Dutch Caribbean, Netherlands
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Brancaleone P, Descamps O, Piquet M, Detry G, Mignon M, Weynand B. [Sertraline-induced chronic eosinophilic pneumonia]. Rev Mal Respir 2021; 38:210-214. [PMID: 33581985 DOI: 10.1016/j.rmr.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/05/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Sertraline is a selective serotonin reuptake inhibitor which is often used as first-line treatment for depression. Several patterns of interstitial lung disease attributable to sertraline have been reported in the literature. CASE REPORT A 69-year-old patient, who had been taking sertraline to treat severe depression for 10 months, presented with a deterioration in his general condition and respiratory symptoms found to be associated with bilateral pneumonitis. An exhaustive assessment did not reveal any infectious or autoimmune aetiology. Transthoracic lung biopsy revealed a pattern of eosinophilic lung disease. Sertraline-induced lung toxicity was then suspected and this treatment was therefore stopped. The patient's symptoms resolved and the chest imaging normalized. CONCLUSIONS Our observation suggests that sertraline was the cause of chronic eosinophilic pneumonia characterized by an insidious clinical presentation several months after starting the medication. Given its widespread prescription, we encourage any clinician facing this disease to pay attention to possible drug-induced origins of lung disease.
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Affiliation(s)
- P Brancaleone
- Service de pneumologie, centres hospitaliers Jolimont, 7100 La Louvière, Belgique.
| | - O Descamps
- Service de médecine interne, centres hospitaliers Jolimont, 7100 La Louvière, Belgique
| | - M Piquet
- Service de pneumologie, centres hospitaliers Jolimont, 7100 La Louvière, Belgique
| | - G Detry
- Laboratoire de biologie clinique, centres hospitaliers Jolimont, 7100 La Louvière, Belgique
| | - M Mignon
- Service de radiologie, centres hospitaliers Jolimont, 7100 La Louvière, Belgique
| | - B Weynand
- Service d'anatomopathologie, universitair ziekenhuis Leuven-Gasthuisberg, 3000 Leuven, Belgique
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Hara K, Yamasaki K, Tahara M, Kimuro R, Yamaguchi Y, Suzuki Y, Kawabata H, Kawanami T, Fujimoto N, Yatera K. Immune checkpoint inhibitors-induced eosinophilic pneumonia: A case report. Thorac Cancer 2021; 12:720-724. [PMID: 33476070 PMCID: PMC7919115 DOI: 10.1111/1759-7714.13848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/02/2021] [Accepted: 01/02/2021] [Indexed: 01/15/2023] Open
Abstract
A 78‐year‐old male with renal cell carcinoma was treated with combined immunotherapy of nivolumab and ipilimumab. After four courses of the treatment, a chest computed tomography (CT) revealed newly formed ground‐glass opacities (GGOs) in both the lower lung lobes; drug‐induced pneumonia was speculated. Eosinophil counts were elevated in both peripheral blood and bronchoalveolar lavage fluid. Both the immune checkpoint inhibitors (ICIs) were discontinued, following which the chest CT findings improved. Based on these findings, a diagnosis of ICI‐induced eosinophilic pneumonia was made. Hence, clinicians should be wary of the risk of eosinophilic pneumonia during ICI‐anticancer therapy.
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Affiliation(s)
- Kanako Hara
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kei Yamasaki
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masahiro Tahara
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Rieko Kimuro
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yudai Yamaguchi
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yu Suzuki
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hiroki Kawabata
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Toshinori Kawanami
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Naohiro Fujimoto
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Descalzo V, Salvador F, Sansano I, Persiva Ó, Antón A, Clofent D, López M, Almirante B. Acute Eosinophilic Pneumonia Associated With SARS-CoV-2 Infection. Arch Bronconeumol 2021; 57:50-52. [PMID: 34629650 PMCID: PMC7831762 DOI: 10.1016/j.arbres.2020.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Vicente Descalzo
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Fernando Salvador
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Irene Sansano
- Department of Pathology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Óscar Persiva
- Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Andrés Antón
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - David Clofent
- Department of Pulmonology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel López
- Department of Pulmonology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Benito Almirante
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
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Abstract
Ceftaroline fosamil is a novel 5th generation broad-spectrum oxyimino-cephalosporin with activity against Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), Streptococcus pneumoniae, Haemophilus influenzae, and Gram-negative bacteria. It has been approved by the United States Food and Drug Administration for the treatment of acute bacterial skin and skin structure infections and community-acquired bacterial pneumonia. There have been reported cases of successful treatment of MRSA bacteremia with this agent. Common adverse drug reactions from ceftaroline include skin rash, hives, neutropenia, thrombocytopenia, and anemia. Acute eosinophilic pneumonia is a rare untoward drug reaction associated with it. We report a case of fever and acute hypoxic respiratory failure with bilateral interstitial pulmonary infiltrates while on ceftaroline therapy for sternal osteomyelitis and ascending aortic graft infection secondary to MRSA. Laboratory studies revealed peripheral blood eosinophilia (>3000 cells/mm3). After exclusion of infectious, autoimmune, and other extrinsic allergic causes of pneumonia, ceftaroline-related acute eosinophilic pneumonia was suspected. Ceftaroline was discontinued and a therapeutic trial of high-dose steroid was initiated. Significant improvement of clinical symptoms and hypoxia was achieved after 24 h of steroid therapy. There was no recurrence of clinical symptoms after completing steroid course, which supported our suspicion of acute eosinophilic pneumonia from ceftaroline. Radiographic improvement of pulmonary infiltrates occurred 4 weeks later with complete resolution at 3 months from the initial event. The current case adds to this rarely reported adverse effect from this relatively newer antimicrobial agent. Increased awareness, early recognition, discontinuation of medication, and steroid therapy are key in favorable clinical outcome and recovery.
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Affiliation(s)
- Zaw Min
- Division of Infectious Disease, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Rawiya Elrufay
- Division of Infectious Disease, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Christian Y Cho
- Department of Pharmacy, Adventist Health Bakersfield, Bakersfield, California, USA
| | - Subbarao Elapavaluru
- Department of Cardiothoracic Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Nitin Bhanot
- Division of Infectious Disease, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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Adhikari P, Alexander K, Ademiluyi AO, Appiah-Pippim J. Sertraline-Induced Acute Eosinophilic Pneumonia. Cureus 2020; 12:e12022. [PMID: 33457126 PMCID: PMC7797414 DOI: 10.7759/cureus.12022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute eosinophilic pneumonia (AEP) is a rare but severe respiratory syndrome characterized by fever, hypoxemic respiratory failure, diffuse pulmonary infiltrates, and pulmonary eosinophilia. The most common cause of AEP is idiopathic, but it can be associated with antidepressant medications like sertraline. A 76-year-old female presented to our ED with acute hypoxemic respiratory failure. She had no history of smoking or prior lung disease. She did not improve after treatment with broad spectrum antibiotics so a trial of corticosteroids was initiated. Her work-up was negative for infectious or collagen vascular causes of the respiratory failure. She was diagnosed with AEP associated with sertraline. Her condition improved with corticosteroid therapy after discontinuation of sertraline. This case report highlights AEP as a possible adverse reaction of sertraline. Prompt discontinuation of the offending drug is necessary for early recovery.
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Affiliation(s)
- Prakash Adhikari
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
| | - Krystal Alexander
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
| | | | - James Appiah-Pippim
- Pulmonary and Critical Care Medicine, Piedmont Athens Regional Medical Center, Athens, USA
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Barry J, Gadre A, Akuthota P. Hypersensitivity pneumonitis, allergic bronchopulmonary aspergillosis and other eosinophilic lung diseases. Curr Opin Immunol 2020; 66:129-135. [PMID: 33166785 DOI: 10.1016/j.coi.2020.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 10/04/2020] [Indexed: 10/23/2022]
Abstract
Hypersensitivity pneumonitis (HP) is traditionally classified into acute, subacute and chronic forms. A high index of suspicion and a detailed investigation into the patient's environment is the key to diagnosis and treatment of HP. Eosinophilic lung diseases can be broadly categorized as idiopathic (acute eosinophilic pneumonia, chronic eosinophilic pneumonia, eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndromes), those with known cause (allergic bronchopulmonary aspergillosis, drugs, parasitic and non-parasitic infections), and those associated with other known lung diseases (asthma, interstitial lung diseases and lung cancers). A detailed review of drug intake, toxin exposures, and travel history is essential in the differential diagnosis of eosinophilic lung diseases.
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Affiliation(s)
- Jeffrey Barry
- Division of Pulmonary, Critical Care & Sleep Medicine, University of California San Diego, La Jolla, CA, United States
| | - Abhishek Gadre
- Division of Pulmonary, Critical Care & Sleep Medicine, University of California San Diego, La Jolla, CA, United States
| | - Praveen Akuthota
- Division of Pulmonary, Critical Care & Sleep Medicine, University of California San Diego, La Jolla, CA, United States.
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Livrieri F, Ghidoni G, Piro R, Menzella F, Cavazza A, Lazzaretti C, Massari M, Montanari G, Fontana M, Facciolongo NC. May 2020: Is It Always COVID-19 No Matter What? Int Med Case Rep J 2020; 13:563-567. [PMID: 33173352 PMCID: PMC7646501 DOI: 10.2147/imcrj.s277474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/08/2020] [Indexed: 12/24/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing a massive outbreak throughout the world. In this period, diseases other than coronavirus disease (COVID-19) have not disappeared; however, it is hard for doctors to diagnose diseases that can mimic the clinical, radiological, and laboratory features of COVID-19, especially rare lung diseases such as acute eosinophilic pneumonia (AEP). We report the clinical case of a young patient who presented to the Emergency Department with respiratory failure and clinical symptoms, radiological aspects, and blood tests compatible with COVID-19; two swabs and a serology test for SARS-CoV-2 were performed, both resulted negative, but the respiratory failure worsened. Peripheral eosinophilia guided us to consider the possibility of a rare disease such as AEP, even if radiology findings were not pathognomonic. Therefore, we decided to perform a flexible bronchoscopy with bronchoalveolar lavage (BAL) at the lingula, which showed the presence of eosinophilia greater than 40%. As a consequence, we treated the patient with high-dose corticosteroids that completely resolved the respiratory symptoms. This case report highlights the difficulty of making alternative diagnoses during the COVID-19 pandemic, especially for rare lung diseases such as AEP, which may have initial characteristics similar to COVID-19.
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Affiliation(s)
- Francesco Livrieri
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia 42123, Italy
| | - Giulia Ghidoni
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia 42123, Italy
| | - Roberto Piro
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia 42123, Italy
| | - Francesco Menzella
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia 42123, Italy
| | - Alberto Cavazza
- Pathology Unit, Azienda USL/IRCCS di Reggio Emilia, Reggio Emilia 42100, Italy
| | - Claudia Lazzaretti
- Infectious Diseases, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Massari
- Infectious Diseases, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gloria Montanari
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia 42123, Italy
| | - Matteo Fontana
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia 42123, Italy
| | - Nicola Cosimo Facciolongo
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia 42123, Italy
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Kalra SS, Chizinga M, Trillo-Alvarez C, Papierniak ES. Ustekinumab associated chronic eosinophilic pneumonia. J Asthma 2020; 58:1670-1674. [PMID: 32962463 DOI: 10.1080/02770903.2020.1827416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Ustekinumab-induced eosinophilic pneumonia is rare and to our knowledge, this is the fifth reported case of such an entity. CASE STUDY A 60-year-old female was admitted with worsening shortness of breath and a nonproductive cough for 4 months. Her past medical history was significant for Crohn's disease and psoriatic arthritis that was previously managed with adalimumab and switched to ustekinumab 2 months before symptoms. Initial diagnostic workup showed 10% peripheral eosinophilia and a CT chest showed numerous 5 mm nodules scattered throughout the lungs along with some peripheral reticulations. Her BAL fluid analysis showed abnormally high eosinophil count (67%), greatly limiting her potential diagnoses to eosinophilic pneumonia, EGPA, and tropical pulmonary eosinophilia (TPE). AEP typically causes more severe disease with a rapid onset, and there was low suspicion for TPE based on history, leaving EGPA and CEP. Based on her negative autoimmune serology, a negative biopsy of the nasal mucosa (no vasculitis/granulomata or eosinophils), and negative infectious workup, the patient was diagnosed with CEP secondary to ustekinumab and the drug was stopped. She was started on high dose prednisone and after a prolonged taper over 5 months, her symptoms and nodules and reticulations on her CT scan resolved. DISCUSSION This case exemplifies the importance of identifying drug-induced lung diseases which in many cases might not have a strong temporal association with the symptom onset. It also highlights that some drugs owing to their long elimination half-time can remain in the system for a prolonged period and continues to cause symptoms despite their cessation and require prolonged treatment and reassurance. CONCLUSION The association of eosinophilic pneumonia with ustekinumab, a drug used in the treatment of psoriasis and other autoimmune diseases, is rare and there is a paucity of literature regarding this association.
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Affiliation(s)
- Saminder Singh Kalra
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Mwelwa Chizinga
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Cesar Trillo-Alvarez
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Eric S Papierniak
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL, USA
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