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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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Asano K, Suzuki Y, Tanaka J, Kobayashi K, Kamide Y. Treatments of refractory eosinophilic lung diseases with biologics. Allergol Int 2023; 72:31-40. [PMID: 36333218 DOI: 10.1016/j.alit.2022.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022] Open
Abstract
Biologics targeting the molecules associated with type 2 inflammation have significantly improved the outcomes of patients with severe eosinophilic asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). Chronic eosinophilic airway/lung diseases including chronic eosinophilic pneumonia, allergic bronchopulmonary aspergillosis/mycosis, eosinophilic bronchitis, and eosinophilic granulomatosis with polyangiitis share clinical features with eosinophilic asthma and CRPwNP, which are mostly adult-onset and may develop simultaneously or consecutively. These eosinophilic airway/lung diseases respond well to initial treatment with systemic corticosteroids, but often recur when the corticosteroids are tapered. The management of these "refractory" cases is an unmet need for clinicians. We first reviewed the standard treatments for these chronic eosinophilic airway/lung diseases, followed by the definition and prevalence of refractory diseases and the role of biologics in their management. The available evidence varies from case reports and case series to randomized control trials, depending on the type of disease; however, these studies provide not only a direction for clinical practice, but also insights into the pathophysiology of each disease. Physicians should discuss the efficacy and costs of biologics in patients with refractory eosinophilic airway/lung diseases to minimize not only the current symptoms, but future risks as well.
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Affiliation(s)
- Koichiro Asano
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan.
| | - Yuzo Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Jun Tanaka
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Konomi Kobayashi
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yosuke Kamide
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan
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3
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Steels S, Proesmans M, Bossuyt X, Dupont L, Frans G. Laboratory biomarkers in the diagnosis and follow-up of treatment of allergic bronchopulmonary aspergillosis in cystic fibrosis. Crit Rev Clin Lab Sci 2023; 60:1-24. [PMID: 35968577 DOI: 10.1080/10408363.2022.2101612] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Allergic bronchopulmonary aspergillosis (ABPA), a severe inflammatory respiratory disease, is caused by a hypersensitivity reaction to the colonization of the airways with Aspergillus fumigatus. It is most often described in patients with asthma or cystic fibrosis. The diagnosis of ABPA is based on a combination of clinical, radiological, and immunological findings that have been included in different diagnostic criteria over the years. In this paper, we review the biomarkers included in these diagnostic criteria and novel research biomarkers that may be used in the diagnosis and treatment follow-up of ABPA in cystic fibrosis.
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Affiliation(s)
- Sophie Steels
- Department of Laboratory Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Marijke Proesmans
- Department of Pediatrics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Xavier Bossuyt
- Department of Laboratory Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Clinical and Diagnostic Immunology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Lieven Dupont
- Department of Respiratory Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Glynis Frans
- Department of Laboratory Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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Challenges in the Differential Diagnosis of COVID-19 Pneumonia: A Pictorial Review. Diagnostics (Basel) 2022; 12:diagnostics12112823. [PMID: 36428883 PMCID: PMC9689132 DOI: 10.3390/diagnostics12112823] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
COVID-19 pneumonia represents a maximum medical challenge due to the virus's high contagiousness, morbidity, and mortality and the still limited possibilities of the health systems. The literature has primarily focused on the diagnosis, clinical-radiological aspects of COVID-19 pneumonia, and the most common possible differential diagnoses. Still, few studies have investigated the rare differential diagnoses of COVID-19 pneumonia or its overlap with other pre-existing lung pathologies. This article presents the main radiological features of COVID-19 pneumonia and the most common alternative diagnoses to establish the vital radiological criteria for a differential diagnosis between COVID-19 pneumonia and other lung pathologies with similar imaging appearance. The differential diagnosis of COVID-19 pneumonia is challenging because there may be standard radiologic features such as ground-glass opacities, crazy paving patterns, and consolidations. A multidisciplinary approach is crucial to define a correct final diagnosis, as an overlap of COVID-19 pneumonia with pre-existing lung diseases is often possible and suggests possible differential diagnoses. An optimal evaluation of HRTC can help limit the clinical evolution of the disease, promote therapy for patients and ensure an efficient allocation of human and economic resources.
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Suzuki T, Nagai K, Wakazono N, Mizushima A, Maeda Y, Taniguchi N, Harada T. Acute eosinophilic pneumonia caused by composter vapor inhalation: A case report. Respir Investig 2022; 60:857-860. [PMID: 36153289 DOI: 10.1016/j.resinv.2022.08.003] [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: 06/09/2022] [Revised: 08/03/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022]
Abstract
A 65-year-old woman presented to a local hospital with a 4-day history of cough, fever, and dyspnea. She had started using a composter and had been exposed to the vapor for 18 days before her first visit. She was diagnosed with acute eosinophilic pneumonia (AEP) based on her symptoms, the presence of bilateral pulmonary opacities on computed tomography, and alveolar eosinophilia confirmed by bronchoalveolar lavage. Inhalation of the composter vapor was thought to be the cause of AEP. Aspergillus fumigatus was cultured from the composter soil and the bronchoalveolar lavage fluid. She fully recovered without systemic corticosteroid administration by avoiding the composter.
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Affiliation(s)
- Takatoshi Suzuki
- Department of Respiratory Medicine, Center for Respiratory Diseases, Japan Community Healthcare Organization (JCHO) Hokkaido Hospital, Japan
| | - Katsura Nagai
- Department of Respiratory Medicine, Center for Respiratory Diseases, Japan Community Healthcare Organization (JCHO) Hokkaido Hospital, Japan.
| | - Nobuyasu Wakazono
- Department of Respiratory Medicine, Center for Respiratory Diseases, Japan Community Healthcare Organization (JCHO) Hokkaido Hospital, Japan
| | - Arei Mizushima
- Department of Respiratory Medicine, Center for Respiratory Diseases, Japan Community Healthcare Organization (JCHO) Hokkaido Hospital, Japan
| | - Yukiko Maeda
- Department of Respiratory Medicine, Center for Respiratory Diseases, Japan Community Healthcare Organization (JCHO) Hokkaido Hospital, Japan
| | - Natsuko Taniguchi
- Department of Respiratory Medicine, Center for Respiratory Diseases, Japan Community Healthcare Organization (JCHO) Hokkaido Hospital, Japan
| | - Toshiyuki Harada
- Department of Respiratory Medicine, Center for Respiratory Diseases, Japan Community Healthcare Organization (JCHO) Hokkaido Hospital, Japan
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Adachi S, Oshikata C, Kaneko T, Tsurikisawa N. Rituximab and dupilumab improve eosinophilic granulomatosis with polyangiitis with multiple pulmonary thrombi. Allergy Asthma Clin Immunol 2022; 18:18. [PMID: 35219344 PMCID: PMC8882302 DOI: 10.1186/s13223-021-00639-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/08/2021] [Indexed: 12/29/2022] Open
Abstract
Background Eosinophilic granulomatosis with polyangiitis (EGPA) is characterized by a necrotizing vasculitis with tissue and peripheral blood eosinophilia affecting small and medium-sized arteries, capillaries, and veins. Venous thromboembolic events are uncommon in EGPA. Moreover, there are only a few reported cases of EGPA complicated by pulmonary embolism or infarction. Case presentation We report the case of a 43-year-old woman with eosinophilic granulomatosis with polyangiitis and acute respiratory and heart failure due to bilateral pulmonary artery thrombosis and left femoral vein thrombosis 12 years after disease onset. She also had cardiac involvement (myocarditis, pericardial effusion, and diastolic dysfunction), gastrointestinal symptoms, and peripheral neuropathy. The condition was refractory to treatment with systemic corticosteroids, intravenous cyclophosphamide, and mepolizumab, but the thrombosis and associated acute cardiac failure, as well as the cardiac and gastrointestinal symptoms and multiple polyneuropathy, improved after a switch to rituximab. However, the heart failure did not improve sufficiently and the patient continued to need inhaled oxygen at 1 L/min and asthma exacerbations occurred. We then swapped the patient’s mepolizumab treatment for dupilumab. Not only did she have no further asthma attacks after switching to dupilumab, but also her vasculitis symptoms improved. Oxygen therapy was discontinued as the heart failure improved 5 months after starting the dupilumab. Conclusions This may be the first case report of the successful treatment by rituximab of pulmonary thromboembolism associated with EGPA. In addition, in this patient, treatment with dupilumab was effective not only for the asthma symptoms but also for the symptoms of vasculitis and heart failure.
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Affiliation(s)
- Sei Adachi
- Department of Allergy and Respirology, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa, 254-0065, Japan
| | - Chiyako Oshikata
- Department of Allergy and Respirology, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa, 254-0065, Japan.,Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Naomi Tsurikisawa
- Department of Allergy and Respirology, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa, 254-0065, Japan. .,Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
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7
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Evaluating the relationship between high-resolution computed tomography findings and their extent in eosinophilic lung diseases with peripheral blood eosinophil level. Pol J Radiol 2021; 86:e542-e547. [PMID: 34820030 PMCID: PMC8607830 DOI: 10.5114/pjr.2021.110643] [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: 07/10/2020] [Accepted: 08/29/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose Eosinophilic lung diseases are a group of pulmonary disorders associated with peripheral or tissue eosinophilia. They can be classified into primary (idiopathic) and secondary groups based on their aetiology. On the other hand, blood eosinophilia is a common clinical problem with various causes. In many cases the lung infiltrations in patients with peripheral eosinophilia are non-eosinophilic. Herein, we aim to assess the relationship between blood eosinophilia and abnormal high-resolution computed tomography (HRCT) features and their extent in idiopathic chronic eosinophilic pneumonia (ICEP) (the most common form of idiopathic eosinophilic lung disease). This can help in differentiating eosinophilic from non-eosinophilic lung infiltrations in patients with blood eosinophilia. Material and methods In this descriptive-correlational study, all patients with proven ICEP, who were referred to Masih Daneshvari Hospital, Tehran, Iran from 2012 to 2019, were included. The ICEP diagnosis was based on lung infiltrations on imaging, in addition to increased numbers of eosinophils in bronchoalveolar lavage fluid, blood or lung biopsy samples, and rapid response to corticosteroids. Patients with known aetiologies for eosinophilic lung diseases were excluded. The HRCT findings and their extent in each patient were compared with the blood eosinophil level. Results Positive correlation was found only between blood eosinophil level and frequency and extent of consolidation, and with frequency of lymphadenopathy. Conclusions HRCT can help to differentiate eosinophilic from non-eosinophilic lung infiltrations in patients with blood eosinophilia by comparing the extent of consolidation with the blood eosinophil level.
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8
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Xu Y, Wang Z, Li W, Zhu Q, Liang Z. Clinical characteristics of patients with chronic eosinophilic pneumonia in a Chinese tertiary-care hospital: A 6-year retrospective study. CLINICAL RESPIRATORY JOURNAL 2021; 16:35-42. [PMID: 34610651 PMCID: PMC9060050 DOI: 10.1111/crj.13448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/12/2021] [Accepted: 09/16/2021] [Indexed: 12/02/2022]
Abstract
Introduction Chronic eosinophilic pneumonia (CEP) is a rare disease with unknown etiology. Due to lack of specificity of CEP symptoms, clinicians are not experienced in establishing its diagnosis. Objectives To summarize the clinical data of CEP patients to improve the understanding of CEP and reduce misdiagnosis. Methods Data of patients pathologically diagnosed with CEP in the PLA General Hospital between May 2013 and May 2019 were collected, and clinical manifestations, imaging characteristics, pathological features, and treatment were retrospectively analyzed. Results Twenty patients, including 6 males and 14 females, were diagnosed with CEP. The average age was 47.0 ± 10.2 years. The main clinical manifestations were cough and dyspnea. The average duration of CEP was 15.5 ± 11.5 months. The average proportion of eosinophils in the peripheral blood was 18.9 ± 17.8%, and the average proportion of eosinophils in the bronchoalveolar lavage fluid was 41.5 ± 19.4%. The main imaging features were patchy shadows and consolidation shadows. The most common manifestations on bronchoscopic examination were congestion and edema of the bronchial mucosa. Two patients had granular protrusions of the endotracheal membrane. Histological examination indicated infiltration of numerous eosinophils. All patients improved after prednisone therapy. Conclusion CEP onset is insidious, and clinical manifestations lack specificity. Typical imaging features are peripheral and subpleural distribution of lung infiltrates. Some patients have a normal proportion of eosinophils in the peripheral blood, but most have an increased number of eosinophils in the BALF, which contributes to CEP diagnosis. A biopsy is necessary when differential diagnosis is difficult. A systemic glucocorticoid is effective.
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Affiliation(s)
- Yang Xu
- Department of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Zhanbo Wang
- Department of Pathology, the first medical center, Chinese PLA General Hospital, Beijing, China
| | - Wenchao Li
- Department of Pediatric Surgery, Chinese PLA General Hospital, Beijing, China
| | - Qiang Zhu
- Department of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Zhixin Liang
- Department of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
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9
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Kawamoto N, Okita R, Hayashi M, Okada M, Ito K, Ikeda E, Inokawa H. Suspected fibrin glue-induced acute eosinophilic pneumonia after pulmonary resection: A case report. Thorac Cancer 2021; 12:2126-2129. [PMID: 34033235 PMCID: PMC8287005 DOI: 10.1111/1759-7714.14040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 12/21/2022] Open
Abstract
Air leakage is a common complication after pulmonary resection, and fibrin glue is used as a sealant to reduce postoperative air leakage. It is generally recognized that fibrin glue‐induced adverse events are rare. Herein, we report a rare case of suspected fibrin glue‐induced acute eosinophilic pneumonia (AEP). A 72‐year‐old man underwent right lower lobectomy and mediastinal lymph node dissection for right lower lung cancer. Fibrin glue was sprayed to cover the interlobar surface of the right upper and middle lobes. On postoperative day 10, computed tomography (CT) revealed ground‐glass shadows around the interlobar surface of the remaining lobes of the right lung. Although antibacterial drugs were administered for suspected bacterial pneumonia, fever spike, shortness of breath, and exacerbation of ground‐glass shadows were observed. Peripheral blood and bronchoalveolar lavage fluid showed increased eosinophil count, supporting the diagnosis of AEP. Pneumonia resolved after prednisolone administration. At one‐year follow‐up, CT showed no AEP recurrence. Drug‐induced pneumonia usually develops in the bilateral lung and rarely in the hemilateral lung. In this case, pneumonia was localized around the site covered with fibrin glue, suggesting fibrin glue‐induced AEP. Thus, the use of fibrin glue should be carefully considered during pulmonary resection.
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Affiliation(s)
- Nobutaka Kawamoto
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Ube, Japan
| | - Riki Okita
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Ube, Japan
| | - Masataro Hayashi
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Ube, Japan
| | - Masanori Okada
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Ube, Japan
| | - Kosuke Ito
- Department of Respiratory Medicine, National Hospital Organization Yamaguchi Ube Medical Center, Ube, Japan
| | - Eiji Ikeda
- Department of Pathology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hidetoshi Inokawa
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Ube, Japan
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10
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Shimoda M, Morimoto K, Tanaka Y, Takemura T, Oka T, Yoshimori K, Ken O. Chronic eosinophilic pneumonitis due to the inhalation of aerosolized face lotion: A case report. Medicine (Baltimore) 2021; 100:e25860. [PMID: 34106632 PMCID: PMC8133146 DOI: 10.1097/md.0000000000025860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Inhalation of toxic agents can induce eosinophilic pneumonia. However, only a few case reports demonstrate that exposure to materials can induce chronic eosinophilic pneumonia (CEP). Here, we describe a rare case of CEP with mild alveolar hemorrhage due to the inhalation of aerosols from face lotion. This is the first report of eosinophilic pneumonia caused by face lotion exposure. PATIENT CONCERNS A 39-year-old woman was admitted to our hospital with cough and dyspnea for 2 months, which coincided when she started to use a new aerosolized face lotion. Laboratory findings showed high blood eosinophil levels, and chest computed tomography (CT) scans revealed bilateral peripheral consolidation and ground-glass opacity mainly in the left upper lobe. She underwent flexible bronchoscopy. Eosinophils in bronchoalveolar lavage fluid (BALF) were slightly elevated, and the gross appearance of BALF was bloody. The histological examination of the transbronchial lung biopsy showed infiltration of eosinophils and macrophages in alveolar septa with edema and without vasculitis and granuloma formation; a small number of hemosiderin-laden macrophages were also observed. An inhalation challenge test involving the face lotion was performed. Six hours after the test, the blood test showed an increased white blood cell (WBC) count, and chest radiography showed slight exacerbation. Forced vital capacity decreased the following day. DIAGNOSIS According to histological analysis and positive result of an inhalation challenge test, she was diagnosed with CEP with mild alveolar hemorrhage due to inhalation of aerosols from the face lotion. INTERVENTIONS AND OUTCOMES She gradually improved without medication after stopping the use of face lotion. LESSONS To the best of our knowledge, this is the first report of CEP with mild alveolar hemorrhage due to the inhalation of face lotion. Various inhaled agents, such as face lotion, can induce CEP in rare cases.
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Affiliation(s)
- Masafumi Shimoda
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo
| | - Kozo Morimoto
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo
| | - Yoshiaki Tanaka
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Tomioka-higashi, Kanazawa-ku, Yokohama, Kanagawa
| | - Teruaki Oka
- Department of Pathology, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
| | - Kozo Yoshimori
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo
| | - Ota Ken
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo
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11
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Shimoda M, Tanaka Y, Fujiwara K, Furuuchi K, Osawa T, Morimoto K, Yano R, Kokutou H, Yoshimori K, Ohta K. Waterproofing spray-associated pneumonitis review: Comparison with acute eosinophilic pneumonia and hypersensitivity pneumonitis. Medicine (Baltimore) 2021; 100:e25054. [PMID: 33725891 PMCID: PMC7969297 DOI: 10.1097/md.0000000000025054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/13/2021] [Indexed: 01/05/2023] Open
Abstract
Waterproofing spray-associated pneumonitis (WAP) proceeds to acute respiratory failure and is characterized by diffuse bilateral ground-glass opacities on computed tomography; however, the detailed characteristics of WAP are unknown. Therefore, this study identified the characteristics of WAP from comparisons with those of acute eosinophilic pneumonia (AEP) and hypersensitivity pneumonitis (HP), which show similar features to WAP.Adult patients with WAP, AEP, and HP treated in Fukujuji Hospital from 1990 to 2018 were retrospectively enrolled. Furthermore, data from patients with WAP were collected from publications in PubMed and the Japan Medical Abstracts Society and combined with data from our patients.Thirty-three patients with WAP, eleven patients with AEP, and thirty patients with HP were reviewed. Regarding age, sex, smoking habit, and laboratory findings (white blood cell count, C-reactive protein level, and serum Krebs von den Lungen-6 level), WAP and AEP were not significantly different, while WAP and HP were significantly different. The duration from symptom appearance to hospital visit was shorter in patients with WAP (median 1 day) than in patients with AEP (median 3 days, P = .006) or HP (median 30 days, P < .001). The dominant cells in the bronchoalveolar lavage fluid of patients with WAP, AEP, and HP were different (macrophages, eosinophils, and lymphocytes, respectively).The characteristic features of WAP were rapid disease progression and macrophage dominance in the bronchoalveolar lavage fluid, and these characteristics can be used to distinguish among WAP, AEP, and HP.
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12
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Ruuth-Praz J, Faure M, Gomez E, Petit I, Petitpain N, Chaouat A, Chabot F. [Eosinophilic pneumonia: A rare complication of sodium divalproate]. Rev Mal Respir 2020; 37:590-594. [PMID: 32739035 DOI: 10.1016/j.rmr.2020.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 05/24/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Eosinophilic pneumonias are characterized by an increase in lung eosinophils. These disorders can be induced by drug reactions. CASE REPORT A 57-year-old woman suffering from bipolar disorder and treated by sodium divalproate for more than 2 years was hospitalised in the department of respiratory medicine for dyspnoea and cough. The investigations showed severe hypoxaemia, airflow limitation, multiple ground-glass opacities and crazy paving on the chest CT-scan and a blood eosinophilia. A significant alveolar eosinophilia was found in the broncho-alveolar lavage. A complete assessment of possible causes was made. Finally, we made the diagnosis of eosinophilic pneumonia secondary to sodium divalproate. The treatment was stopped and systemic corticosteroid therapy was not introduced. The patient showed an improvement of her dyspnoea in a few days. Lung function and the CT-scan were normal within a few months. CONCLUSIONS Sodium divalproate, frequently used in the treatment of bipolar disorder, is a rare cause of eosinophilic lung disease, even years after its introduction. Rapid diagnosis and withdrawal of treatment led to complete resolution in the reported case.
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Affiliation(s)
- J Ruuth-Praz
- Département de pneumologie, CHRU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - M Faure
- Service de pneumologie, médecine intensive et réanimation, Groupe hospitalier Pitié-Salpêtrière, Paris, France
| | - E Gomez
- Département de pneumologie, CHRU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - I Petit
- Département de radiologie, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - N Petitpain
- Service de toxicologie et pharmacologie clinique, Centre régional de pharmacovigilance, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - A Chaouat
- Département de pneumologie, CHRU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - F Chabot
- Département de pneumologie, CHRU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
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Abstract
We herein report a case of refractory chronic eosinophilic pneumonia (CEP) complicated with uncontrolled bronchial asthma, in which remission was successfully induced with single dose of benralizumab, a monoclonal antibody against the alpha-chain of the interleukin-5 receptor. Resolution of the patient's symptoms and consolidation on chest X-ray were observed at 2 weeks and lasted for 8 weeks after the administration of benralizumab. Benralizumab would be a novel alternative choice of treatment for CEP patients who are at risk of potential toxicity due to long-term corticosteroid therapy.
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Affiliation(s)
- Kohsuke Isomoto
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
- Department of Medical Oncology, Kindai University Faculty of Medicine, Japan
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Naoto Aiko
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
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14
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Possible Mechanisms of Eosinophil Accumulation in Eosinophilic Pneumonia. Biomolecules 2020; 10:biom10040638. [PMID: 32326200 PMCID: PMC7226607 DOI: 10.3390/biom10040638] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/12/2020] [Accepted: 04/20/2020] [Indexed: 12/29/2022] Open
Abstract
Eosinophilic pneumonia (EP), including acute EP and chronic EP, is characterized by the massive pulmonary infiltration of eosinophils into the lung. However, the mechanisms underlying the selective accumulation of eosinophils in EP have not yet been fully elucidated. We reported that bronchoalveolar lavage fluid (BALF) from EP patients induced the transmigration of eosinophils across endothelial cells in vitro. The concentrations of eotaxin-2 (CCL24) and monocyte chemotactic protein (MCP)-4 (CCL13), which are CC chemokine receptor (CCR) 3 ligands, were elevated in the BALF of EP patients, and anti-CCR3 monoclonal antibody inhibited the eosinophil transmigration induced by the BALF of EP patients. The concentration of macrophage inflammatory protein 1β (CCL4), a CCR5 ligand that induces eosinophil migration, was increased in the BALF of EP patients. Furthermore, the concentration of interleukin (IL) 5 was increased in the BALF of EP patients, and it has been reported that anti-IL-5 antibody treatment resulted in remission and the reduction of glucocorticoid use in some cases of chronic EP. The concentrations of lipid mediators, such as leukotriene (LT) B4, damage-associated molecular pattern molecules (DAMPs), such as uric acid, or extracellular matrix proteins, such as periostin, were also increased in the BALF of EP patients. These findings suggest that chemokines, such as CCR3/CCR5 ligands, cytokines, such as IL-5, lipid mediators, such as LTB4, DAMPs, and extracellular matrix proteins may play roles in the accumulation or activation of eosinophils in EP.
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15
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Underner M, Perriot J, Peiffer G, Urban T, Jaafari N. [Acute eosinophilic pneumonia and illicit psychoactive substance use]. Rev Mal Respir 2019; 37:34-44. [PMID: 31862136 DOI: 10.1016/j.rmr.2019.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/11/2019] [Indexed: 02/08/2023]
Abstract
Illicit psychoactive substance (IPAS) use can lead to a number of respiratory complications, including acute eosinophilic pneumonia (AEP). Systematic literature review of data on AEP in IPAS users (cannabis, cocaine, heroin and amphetamine). Of two cases of cannabis and tobacco users reported to have developed AEP, one, a teenage15 year old boy presented with acute respiratory distress syndrome (ARSD) which necessitated extracorporeal membrane oxygenation (ECMO). Five cases of AEP in cocaine smokers (crack) are reported, one of which was fatal. The patient presented with acute pulmonary edema and ARDS which progressed to ventricular fibrillation and asystole. A 24-year-old woman presented with AEP after repeated inhalation of heroin. Finally, a case of an amphetamine abuser who developed AEP and ARDS after amphetamine inhalation is reported. The time between the first IPAS use and admission in cases reported ranged from 7 days to 4 years, while time between the last IPAS use and admission was short (less than 15 days). IPAS use must be sought in case of AEP, especially in young adults, and practitioners must advise and help users to stop their consumption.
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Affiliation(s)
- M Underner
- Unité de recherche clinique, université de Poitiers, centre hospitalier Henri Laborit, 86021 Poitiers, France.
| | - J Perriot
- Dispensaire Emile Roux, Centre de tabacologie, 63100 Clermont-Ferrand, France
| | - G Peiffer
- Service de pneumologie, CHR Metz-Thionville, 57038 Metz, France
| | - T Urban
- Service de pneumologie, CHU d'Angers, 4, rue Larrey, 49933 Angers, France
| | - N Jaafari
- Unité de recherche clinique, université de Poitiers, centre hospitalier Henri Laborit, 86021 Poitiers, France
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16
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Abstract
Acute respiratory distress syndrome (ARDS) was first described in 1967 by Ashbaugh and colleagues. Acute respiratory distress syndrome is a clinical syndrome, not a disease, and has no ideal definition or gold standard diagnostic test. There are multiple causes and different pathways of pathogenesis as well as various histological findings. Given these variations, there are many clinical entities that can get confused with ARDS. These entities are discussed in this article as "Mimics of ARDS." It imperative to correctly identify ARDS and distinguish it from other diseases to implement correct management strategy.
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17
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A Case of Allergic Bronchopulmonary Aspergillosis (ABPA) in a Patient with a History of Cocaine Use and Tuberculosis. Case Rep Med 2019; 2019:3265635. [PMID: 31871461 PMCID: PMC6907060 DOI: 10.1155/2019/3265635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/27/2019] [Accepted: 11/11/2019] [Indexed: 01/24/2023] Open
Abstract
Aspergillosis refers to a spectrum of disorders that can occur due to colonization with the Aspergillus fungus. Allergic bronchopulmonary aspergillosis (ABPA) is an airway hypersensitivity reaction to the fungus that is almost exclusively seen in patients with cystic fibrosis or asthma. Here, we present a case of ABPA in a patient with a history of chronic cocaine use and tuberculosis and no history of asthma or cystic fibrosis. The patient had presented with progressively worsening dyspnea for three months as well as a 20-pound weight loss. Diagnosis was made with an elevated IgE against Aspergillus and chest CT findings, which included bronchiectasis and tree-in-bud nodular opacities. The patient was treated with IV methylprednisolone followed by a 4-day course of oral prednisone, with significant improvement. It is our hope to make healthcare providers aware of the potential presence of ABPA in chronic cocaine users and patients with tuberculosis, both of which are not traditionally associated with this condition.
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18
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Eosinophilic pneumonia: A review of the previous literature, causes, diagnosis, and management. Allergol Int 2019; 68:413-419. [PMID: 31253537 DOI: 10.1016/j.alit.2019.05.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/18/2019] [Indexed: 12/24/2022] Open
Abstract
Eosinophilic pneumonia (EP) is a rare disorder, comprising several heterogeneous diseases. Two major types of EP are acute eosinophilic pneumonia (AEP) and chronic eosinophilic pneumonia (CEP), both of which are characterized by marked accumulation of eosinophils in lung tissues and/or BAL fluid. AEP and CEP share some similarities in terms of pathophysiology, radiological findings, and treatment response to corticosteroids. However, they distinctly differ in etiology, clinical manifestations, and the nature of disease course. Especially, although AEP and CEP respond well to corticosteroids, relapse frequently occurs in patients with CEP, but rarely in those with AEP. Although CEP occasionally persists and becomes corticosteroid dependent, most patients with AEP completely recover. This article reviews previous studies and discusses the etiology, clinical manifestations, and treatment of AEP and CEP.
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19
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LeVee A, Trieu M, Bhattacharyya S, Sandhu G. Eosinophilic pneumonia: A rare manifestation of amiodarone toxicity diagnosed using traditional bronchoscopy. Respir Med Case Rep 2019; 27:100856. [PMID: 31193451 PMCID: PMC6527914 DOI: 10.1016/j.rmcr.2019.100856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/08/2019] [Accepted: 05/13/2019] [Indexed: 11/03/2022] Open
Abstract
Amiodarone is an antiarrhythmic agent used primarily to treat atrial and ventricular arrhythmias. However, the drug also has many adverse effects, including pulmonary toxicity, and a wide range of pulmonary diseases have been reported. Amiodarone-induced eosinophilic pneumonia is a relatively rare adverse effect with an incidence ranging between 5 and 13% [1]. The majority of cases have been diagnosed with lung biopsy, with only one prior reported case diagnosed by bronchoalveolar lavage (BAL) [2]. This report describes the second documented case of amiodarone-induced eosinophilic pneumonia diagnosed by eosinophilia on BAL cytology. In this case, complete cessation of symptoms occurred after discontinuation of amiodarone and treatment with corticosteroids. An updated review of the literature of amiodarone-induced eosinophilic pneumonia is also detailed.
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Affiliation(s)
- Alexis LeVee
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Megan Trieu
- Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | | | - Gurveen Sandhu
- Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
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20
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Dias OM, Nascimento ECTD, Chate RC, Kairalla RA, Baldi BG. Eosinophilic pneumonia: remember topical drugs as a potential etiology. ACTA ACUST UNITED AC 2019; 44:522-524. [PMID: 30726330 PMCID: PMC6459750 DOI: 10.1590/s1806-37562018000000028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Affiliation(s)
- Olívia Meira Dias
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | - Rodrigo Caruso Chate
- . Divisão de Radiologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Ronaldo Adib Kairalla
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Bruno Guedes Baldi
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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21
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Abstract
RATIONALE Acute eosinophilic pneumonia (AEP) is a rare pulmonary disease, which is characterized by diffuse pulmonary eosinophilia. The pathogenesis remains unknown. Here we report a patient with AEP following a recently acquired habit of smoking. PATIENT CONCERNS A 21-year-old female presented with fever, dry cough, and acute hypoxic respiratory distress for 2 days. Chest computed tomography showed bilateral ground glass opacities, patchy nodules, and pleural effusions. Blood tests showed a gradually raised peripheral eosinophils level. DIAGNOSES Bronchoalveolar lavage fluid revealed marked elevation of eosinophils. She was diagnosed with AEP. INTERVENTIONS Systemic methylprednisolone was immediately used for treatment. OUTCOMES Her clinical symptoms and chest radiographs improved promptly after treatment. LESSONS Cigarette smoking might be an underlying triggering factor of AEP. Diffuse alveolar infiltrates and a gradually increasing peripheral eosinophilia should raise the concern especially in recent smoking patients.
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Affiliation(s)
- Xing Liu
- Department of Respiratory Medicine, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian
| | - Wangyuan Sun
- Department of Respiratory Medicine, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian
| | - Wenshu Meng
- Department of Respiratory Medicine, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian
| | - Yonglong Xiao
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing
| | - Ganzhu Feng
- Department of Respiratory Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bin Shi
- Department of Respiratory Medicine, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian
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22
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Trimble AC, Beard LA, Davis EG. A case of idiopathic eosinophilic pneumonia in a Quarter Horse gelding. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.12753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A. C. Trimble
- Kansas State University Veterinary Health Center; Manhattan Kansas USA
| | - L. A. Beard
- Kansas State University Veterinary Health Center; Manhattan Kansas USA
| | - E. G. Davis
- Kansas State University Veterinary Health Center; Manhattan Kansas USA
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23
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Aokage T, Tsukahara K, Fukuda Y, Tokioka F, Taniguchi A, Naito H, Nakao A. Heat-not-burn cigarettes induce fulminant acute eosinophilic pneumonia requiring extracorporeal membrane oxygenation. Respir Med Case Rep 2018; 26:87-90. [PMID: 30560050 PMCID: PMC6288977 DOI: 10.1016/j.rmcr.2018.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/30/2018] [Accepted: 12/02/2018] [Indexed: 12/12/2022] Open
Abstract
Background Although the cause of acute eosinophilic pneumonia (AEP) has not yet been fully clarified, cigarette smoking is reported to be a risk factor for developing AEP. The heat-not-burn cigarette (HNBC) was developed to reduce the adverse effects of smoke on the user's surroundings. However, the health risks associated with HNBCs have not yet been clarified. We report a successfully treated case of fatal AEP presumably induced by HNBC use. Presentation of case A 16-year-old man commenced HNBC smoking two weeks before admission and subsequently suffered from shortness of breath that gradually worsened. The patient was transferred to emergency department and immediately intubated because of respiratory failure. Computed tomography showed mosaic ground-glass shadows on the distal side of both lungs with a PaO2/FIO2 ratio of 76. The patient required veno-venous extracorporeal membrane oxygenation (ECMO) for severe respiratory failure. He was diagnosed with AEP by clinical course and detection of eosinophils in sputum; thus, methylprednisolone was administrated. The patient was weaned off ECMO four days after initiation and extubated the day after. He fully recovered without sequelae. Conclusion As far as we know, our patient is the first case of AEP induced by HNBC use successfully treated with ECMO. Emergency physicians must be aware that HNBCs can induce fatal AEP. The use of heat-not-burn cigarettes has been increasing in recent years. The effects of heat-not-burn cigarettes on health have not yet been clarified. Heat-not-burn cigarettes possibly induce acute eosinophilic pneumonia. Extracorporeal membrane oxygenation was effective in a patient with a severe case of acute eosinophilic pneumonia.
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Key Words
- AEP, acute eosinophilic pneumonia
- Acute eosinophilic pneumonia
- BAL, bronchoalveolar lavage
- CT, computed tomography
- Cigarettes
- ECMO
- ECMO, extracorporeal membrane oxygenation
- Extracorporeal membrane oxygenation
- FIO2, fraction of inspiratory oxygen
- HNBC, heat-not-burn cigarette
- Heat-not-burn cigarettes
- IV, intravenous administration
- PEEP, positive end-expiratory pressure
- PSL, prednisolone
- PaO2, partial pressure of arterial oxygen
- Pplat, plateau pressure
- SpO2, oxygen saturation of pulse oximetry
- Tobacco
- VV, veno-venous
- mPSL, methylprednisolone
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Affiliation(s)
- Toshiyuki Aokage
- Department of Geriatric Emergency Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Corresponding author. Department of Geriatric Emergency Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Kohei Tsukahara
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasushi Fukuda
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Fumiaki Tokioka
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Akihiko Taniguchi
- Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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24
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A 62-Year-Old Man with Cough and Dyspnea after Crack Cocaine Inhalation. Ann Am Thorac Soc 2018; 13:1416-8. [PMID: 27509155 DOI: 10.1513/annalsats.201603-168cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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25
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Long-term management and persistent impairment of pulmonary function in chronic eosinophilic pneumonia: A review of the previous literature. Allergol Int 2018; 67:334-340. [PMID: 29395966 DOI: 10.1016/j.alit.2017.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/05/2017] [Accepted: 12/04/2017] [Indexed: 01/15/2023] Open
Abstract
Chronic eosinophilic pneumonia (CEP) is an inflammatory disease characterized by accumulations of eosinophils in the lung with unknown etiology. Although corticosteroid treatment dramatically resolves these inflammations, relapse is common during the course of the disease. Approximately 50% of patients with CEP experience relapse. Subsequent to persistent disease and repeated relapse, and in cases of combined severe asthma, some CEP patients are administered corticosteroids indefinitely. Similar to patients with severe asthma who are often steroid dependent, a number of CEP patients exhibit prolonged persistent impairment of pulmonary function. Thus, CEP should be considered a potentially chronic disease requiring long-term management, rather than an acute or sub-acute disease requiring short-time therapy only. This review summarizes previous CEP studies, as well as our own cohort data, and discusses the long-term management of CEP with a particular focus on relapse, the prevalence of maintenance therapy, and persistent impairment of pulmonary function.
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26
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Katsumata Y, Ikari J, Tanaka N, Abe M, Tsushima K, Yonemori Y, Tatsumi K. Tocilizumab-effective multicentric Castleman's disease with infiltration of eosinophil and IgG 4-positive plasma cells: A case report. Respir Med Case Rep 2018; 25:25-29. [PMID: 29998054 PMCID: PMC6038330 DOI: 10.1016/j.rmcr.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/01/2018] [Accepted: 06/01/2018] [Indexed: 12/24/2022] Open
Abstract
A 67-year-old woman with fever and cough was diagnosed with eosinophilic pneumonia because of eosinophilia and increased eosinophil levels in the bronchoalveolar lavage fluid and transbronchial biopsy lung specimens. However, prednisolone therapy at a previous hospital was ineffective. Histological findings from thoracoscopic lung and lymph node biopsies were consistent with multicentric Castleman's disease (MCD). Since specimens also showed prominent eosinophil and IgG4-positive plasma cell infiltration, it was difficult to distinguish IgG4-related disease (IgG4-RD) from MCD. Administration of prednisolone plus tocilizumab improved the symptoms and lung lesions, and prednisolone administration was successfully reduced and then terminated. The present case highlights the difficulty in diagnosing MCD and IgG4-RD, and suggests that combined administration of tocilizumab and prednisolone might be effective in such a case.
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Key Words
- BALF, bronchoalveolar lavage fluid
- CRP, C-reactive protein
- CT, computed tomography
- EGPA, eosinophilic granulomatosis with polyangiitis
- EP, eosinophilic pneumonia
- HPF, high-powered field
- IgG4-RD, IgG4-related disease
- MCD, multicentric Castleman's disease
- PSL, prednisolone
- TBLB, transbronchial lung biopsy
- UCD, unicentric Castleman's disease
- WBC, white blood cell
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Affiliation(s)
- Yusuke Katsumata
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
- Corresponding author. Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku Chiba 260-8670, Japan.
| | - Jun Ikari
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Nozomi Tanaka
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Mitsuhiro Abe
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Kenji Tsushima
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Yoko Yonemori
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
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27
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Krabansky F, Azzouz B, Biya J, Abou Taam M, Morel A, Trenque T. Eosinophilic pneumonia induced by non-steroidal anti-inflammatory drugs: An underestimated risk. Therapie 2018; 73:473-482. [PMID: 29789133 DOI: 10.1016/j.therap.2018.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/18/2018] [Accepted: 03/19/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Eosinophilic pneumonia (EP) is a rare but serious adverse drug reaction (ADR) induced by non-steroidal anti-inflammatory drugs (NSAIDs). METHODS We describe the second published case of EP induced by oral diclofenac. We also reviewed the literature as well as French pharmacovigilance database. Case presentation A 63 year-old woman with polyarthralgia had taken diclofenac for three days for analgesic purposes. Progressively, the patient presented weakness, dyspnea and fever. Computed tomography (CT) scan revealed bilateral interstitial infiltration. Broncho-alveolar lavage (BAL) showed an elevated level of eosinophils. After ruling out all other possible etiologies, drug-induced EP was diagnosed and treatment by corticosteroid was initiated. The patient recovered in three months. RESULTS In the French pharmacovigilance database, six cases of EP were recorded (3 with naproxen, 2 with ibuprofen, 1 with piroxicam). In the literature, twenty-six cases of EP with NSAIDs were published. The most commonly involved drug was naproxen (n=8), followed by fenbufen (n=4), ibuprofen (n=3) and diclofenac (n=2). A high level of eosinophils was systematically observed in the blood cell count or BAL. Corticosteroid therapy was started in eleven cases. All patients recovered. CONCLUSION Complete history taking and examination should be done to rule out other etiological diagnoses. BAL is sufficient to diagnose EP. Corticosteroid therapy should be indicated for more severe or refractory cases. This adverse drug reaction is underestimated, healthcare professionals should be informed.
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Affiliation(s)
- François Krabansky
- Reims university hospitals, regional centre of pharmacovigilance and pharmacoepidemiology, avenue du Général Koening, 51092 Reims cedex, France
| | - Brahim Azzouz
- Reims university hospitals, regional centre of pharmacovigilance and pharmacoepidemiology, avenue du Général Koening, 51092 Reims cedex, France.
| | - Josette Biya
- Reims university hospital, respiratory diseases unit, avenue du Général Koening, 51092 Reims, France
| | - Malak Abou Taam
- Reims university hospitals, regional centre of pharmacovigilance and pharmacoepidemiology, avenue du Général Koening, 51092 Reims cedex, France
| | - Aurore Morel
- Reims university hospitals, regional centre of pharmacovigilance and pharmacoepidemiology, avenue du Général Koening, 51092 Reims cedex, France
| | - Thierry Trenque
- Reims university hospitals, regional centre of pharmacovigilance and pharmacoepidemiology, avenue du Général Koening, 51092 Reims cedex, France
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28
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Suzuki Y, Oyama Y, Hozumi H, Imokawa S, Toyoshima M, Yokomura K, Nakamura H, Kuroishi S, Karayama M, Furuhashi K, Enomoto N, Fujisawa T, Nakamura Y, Inui N, Koshimizu N, Yamada T, Mori K, Masuda M, Shirai T, Hayakawa H, Sumikawa H, Johkoh T, Suda T. Persistent impairment on spirometry in chronic eosinophilic pneumonia: A longitudinal observation study (Shizuoka-CEP study). Ann Allergy Asthma Immunol 2017; 119:422-428.e2. [PMID: 28942952 DOI: 10.1016/j.anai.2017.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Chronic eosinophilic pneumonia (CEP) is characterized by the accumulation of eosinophils in the lung with unknown etiology. Although systemic corticosteroid administration leads to dramatic improvement, nearly half the patients with CEP experience relapse and some develop persistent impairment of pulmonary function. However, predictive factors for this persistent impairment have not been determined. OBJECTIVE To investigate the occurrence of persistent impairment of pulmonary function in CEP and determine its predictive factors. METHODS This observational study consisted of 133 consecutive patients with CEP who were followed for longer than 1 year. Spirometry was performed at the time of diagnosis and at follow-up. RESULTS During the observational period (6.1 ± 4.1 years), relapse occurred in 75 patients (56.4%). Remarkably, 42 patients (31.6%) had a persistent pulmonary function defect (27 obstructive, 10 restrictive, and 4 obstructive and restrictive cases) at the last evaluation. Logistic analyses showed that the relapse was associated with neither persistent obstructive nor restrictive defects. Persistent obstructive defect was significantly associated with the comorbidity of asthma and obstructive defect at the initial CEP diagnosis, whereas persistent restrictive defect was significantly related to reticulation at high-resolution computer tomography and restrictive defect at diagnosis. CONCLUSION Persistent impairment of pulmonary function is common in CEP. Concurrent asthma and obstructive defects at diagnosis were predictors for persistent obstructive impairments, whereas reticulation at high-resolution computer tomography and restrictive defect at diagnosis predicted persistent restrictive impairment. Attention should be paid to these persistent impairments in the management of CEP. TRIAL REGISTRATION http://www.umin.ac.jp/ctr/index-j.htm Identifier: UMIN000019092 (principal investigator, Takafumi Suda, MD, PhD).
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Affiliation(s)
- Yuzo Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Yoshiyuki Oyama
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shiro Imokawa
- Respiratory Medicine, Iwata City Hospital, Iwata, Japan
| | - Mikio Toyoshima
- Respiratory Medicine, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Koshi Yokomura
- Respiratory Medicine, Seirei-Mikatahara General Hospital, Hamamatsu, Japan
| | - Hidenori Nakamura
- Respiratory Medicine, Seirei-Hamamatsu General Hospital, Hamamatsu, Japan
| | | | - Masato Karayama
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuki Furuhashi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | - Takashi Yamada
- Respiratory Medicine, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Kazutaka Mori
- Respiratory Medicine, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Masafumi Masuda
- Respiratory Medicine, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Toshihiro Shirai
- Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Hiroshi Hayakawa
- Respiratory Medicine, Tenryu Hospital, National Hospital Organization, Hamamatsu, Japan
| | - Hiromitsu Sumikawa
- Department of Diagnostic Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - Takeshi Johkoh
- Department of Radiology, Kinki Central Hospital, Itami, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Kobayashi T, Nakagome K, Noguchi T, Kobayashi K, Ueda Y, Soma T, Ikebuchi K, Nakamoto H, Nagata M. Elevated uric acid and adenosine triphosphate concentrations in bronchoalveolar lavage fluid of eosinophilic pneumonia. Allergol Int 2017; 66S:S27-S34. [PMID: 28705588 DOI: 10.1016/j.alit.2017.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/05/2017] [Accepted: 06/09/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Recent evidence has suggested that the innate immune response may play a role in the development of eosinophilic airway inflammation. We previously reported that uric acid (UA) and adenosine triphosphate (ATP), two important damage-associated molecular pattern molecules (DAMPs), activate eosinophil functions, suggesting that these molecules may be involved in the development of eosinophilic airway inflammation. The objective of this study was to measure the concentrations of DAMPs including UA and ATP in the bronchoalveolar lavage fluid (BALF) of patients with eosinophilic pneumonia (EP). METHODS BAL was performed in patients with EP including acute and chronic eosinophilic pneumonia, and in patients with hypersensitivity pneumonia, and sarcoidosis. UA, ATP, and cytokine concentrations in the BALF were then measured. RESULTS The UA concentration was increased in the BALF of EP patients. UA concentrations correlated with eosinophil numbers, and with eosinophil-derived neurotoxin and interleukin (IL)-5 concentrations. Furthermore, the ATP concentration was increased in the BALF of EP patients and ATP concentrations correlated with UA concentrations. Moreover, IL-33 was increased in EP patients and IL-33 concentrations correlated with UA and ATP concentrations. CONCLUSIONS The UA and ATP concentration was increased in the BALF of EP patients. UA concentrations correlated with eosinophil numbers, and with ATP and IL-33 concentrations. Our findings suggest that DAMPs such as UA and ATP play a role in the pathogenesis of EP.
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Abstract
OBJECTIVE The purpose of this article is to review the clinical and imaging findings associated with eosinophilic lung diseases. CONCLUSION The spectrum of eosinophilic lung diseases comprises a diverse group of pulmonary disorders that have an association with tissue or peripheral eosinophilia. These diseases have varied clinical presentations and may be associated with several other abnormalities. Characteristic imaging findings are often detected with chest radiography, and CT best shows parenchymal abnormalities. The integration of clinical, radiologic, and pathologic findings facilitates diagnosis and directs appropriate treatment.
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31
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Nakagome K, Shoda H, Shirai T, Nishihara F, Soma T, Uchida Y, Sakamoto Y, Nagata M. Eosinophil transendothelial migration induced by the bronchoalveolar lavage fluid of acute eosinophilic pneumonia. Respirology 2017; 22:913-921. [PMID: 28139852 DOI: 10.1111/resp.12982] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 10/16/2016] [Accepted: 11/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Acute eosinophilic pneumonia (AEP) is characterized by a massive pulmonary infiltration of eosinophils. Mechanisms regulating the selective accumulation of eosinophils in AEP have not been fully established. The objective of this study was to evaluate the mechanisms of eosinophil accumulation in alveolar spaces through examination of bronchoalveolar lavage fluid (BALF) from AEP patients (AEP-BALF). METHODS Eosinophils were isolated from the blood of healthy subjects and were placed on a human pulmonary microvascular endothelial cell monolayer cultured on Transwell filters (Coster, Cambridge, MA, USA). A saline control solution or BALF from patients with AEP, sarcoidosis or hypersensitivity pneumonitis was applied to the lower compartment, and the transendothelial migration of the eosinophils was evaluated. The concentrations of cytokines and chemokines in BALF were also measured. RESULTS Transmigration of eosinophils across endothelial cells was only induced by the AEP-BALF. This transmigration was blocked by anti-β2 integrin mAb. The concentrations of eotaxin-2 and monocyte chemotactic protein (MCP)-4, which are CC chemokine receptor (CCR) 3 ligands, were elevated in the AEP-BALF, and anti-CCR3 mAb or anti-MCP-4 mAb inhibited the AEP-BALF-induced transmigration of eosinophils. Furthermore, the concentration of leukotriene (LT) B4 was increased in the AEP-BALF, and an LTB4 receptor antagonist partially suppressed the AEP-BALF-induced transmigration of eosinophils. CONCLUSION These findings suggest that CCR3 ligands including eotaxin-2 and MCP-4, and LTB4 play a role in the accumulation of eosinophils in AEP.
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Affiliation(s)
- Kazuyuki Nakagome
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan.,Allergy Center, Saitama Medical University, Saitama, Japan
| | - Hisakazu Shoda
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Tetsu Shirai
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Fuyumi Nishihara
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan.,Allergy Center, Saitama Medical University, Saitama, Japan
| | - Tomoyuki Soma
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan.,Allergy Center, Saitama Medical University, Saitama, Japan
| | - Yoshitaka Uchida
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan.,Allergy Center, Saitama Medical University, Saitama, Japan
| | - Yoshio Sakamoto
- Department of Internal Medicine, Fureai Yokohama Hospital, Yokohama, Japan
| | - Makoto Nagata
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan.,Allergy Center, Saitama Medical University, Saitama, Japan
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32
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Katre RS, Sunnapwar A, Restrepo CS, Katabathina VS, Mumbower A, Baxi A, Sonavane S. Cardiopulmonary and Gastrointestinal Manifestations of Eosinophil- associated Diseases and Idiopathic Hypereosinophilic Syndromes: Multimodality Imaging Approach. Radiographics 2017; 36:433-51. [PMID: 26963455 DOI: 10.1148/rg.2016150145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Eosinophil-associated diseases (EADs) are a diverse group of disorders characterized by an increase in circulating or tissue eosinophils. Cardiopulmonary and gastrointestinal system involvement can be due to primary EAD with no known cause or can be secondary to known systemic disease. The cardiopulmonary spectrum of EADs comprises simple pulmonary eosinophilia, acute eosinophilic pneumonia, chronic eosinophilic pneumonia, Churg-Strauss syndrome, allergic bronchopulmonary aspergillosis, bronchocentric granulomatosis, parasitic infections, and idiopathic hypereosinophilic syndrome. Eosinophilic gastrointestinal disorders include eosinophilic esophagitis, eosinophilic gastroenteritis, and eosinophilic colitis. Diagnosis is often challenging and requires a combination of clinical and imaging features along with laboratory findings. The absolute eosinophil count in peripheral blood and the percentage of eosinophils in bronchoalveolar lavage fluid are crucial in evaluation of various eosinophilic lung diseases. Although chest radiography is the initial imaging modality used in suspected cases of pulmonary EAD, multidetector computed tomography may demonstrate more characteristic pulmonary patterns, nodules, and subtle parenchymal abnormalities. Barium esophagography is used to assess mucosal abnormalities and the length and diameter of esophageal strictures. Magnetic resonance imaging is superior in providing valuable information in select patients, especially in evaluation of cardiac and gastrointestinal system involvement. Many patients require a multimodality imaging approach to enable diagnosis, guide treatment, and assess treatment response. Knowledge of the clinical features and imaging findings of the spectrum of EADs involving the lungs, heart, and gastrointestinal tract permits optimal patient care.
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Affiliation(s)
- Rashmi S Katre
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (R.S.K., A.S., C.S.R., V.S.K., A.M., A.B.); and Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (S.S.)
| | - Abhijit Sunnapwar
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (R.S.K., A.S., C.S.R., V.S.K., A.M., A.B.); and Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (S.S.)
| | - Carlos S Restrepo
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (R.S.K., A.S., C.S.R., V.S.K., A.M., A.B.); and Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (S.S.)
| | - Venkata S Katabathina
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (R.S.K., A.S., C.S.R., V.S.K., A.M., A.B.); and Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (S.S.)
| | - Amy Mumbower
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (R.S.K., A.S., C.S.R., V.S.K., A.M., A.B.); and Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (S.S.)
| | - Ameya Baxi
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (R.S.K., A.S., C.S.R., V.S.K., A.M., A.B.); and Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (S.S.)
| | - Sushilkumar Sonavane
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (R.S.K., A.S., C.S.R., V.S.K., A.M., A.B.); and Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (S.S.)
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Eng SS, DeFelice ML. The Role and Immunobiology of Eosinophils in the Respiratory System: a Comprehensive Review. Clin Rev Allergy Immunol 2016; 50:140-58. [PMID: 26797962 DOI: 10.1007/s12016-015-8526-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The eosinophil is a fully delineated granulocyte that disseminates throughout the bloodstream to end-organs after complete maturation in the bone marrow. While the presence of eosinophils is not uncommon even in healthy individuals, these granulocytes play a central role in inflammation and allergic processes. Normally appearing in smaller numbers, higher levels of eosinophils in the peripheral blood or certain tissues typically signal a pathologic process. Eosinophils confer a beneficial effect on the host by enhancing immunity against molds and viruses. However, tissue-specific elevation of eosinophils, particularly in the respiratory system, can cause a variety of short-term symptoms and may lead to long-term sequelae. Eosinophils often play a role in more commonly encountered disease processes, such as asthma and allergic responses in the upper respiratory tract. They are also integral in the pathology of less common diseases including eosinophilic pneumonia, allergic bronchopulmonary aspergillosis, hypersensitivity pneumonitis, and drug reaction with eosinophilia and systemic symptoms. They can be seen in neoplastic disorders or occupational exposures as well. The involvement of eosinophils in pulmonary disease processes can affect the method of diagnosis and the selection of treatment modalities. By analyzing the complex interaction between the eosinophil and its environment, which includes signaling molecules and tissues, different therapies have been discovered and created in order to target disease processes at a cellular level. Innovative treatments such as mepolizumab and benralizumab will be discussed. The purpose of this article is to further explore the topic of eosinophilic presence, activity, and pathology in the respiratory tract, as well as discuss current and future treatment options through a detailed literature review.
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Affiliation(s)
- Stephanie S Eng
- Thomas Jefferson University, Philadelphia, PA, USA
- Division of Allergy and Immunology, Nemours/AI duPont Hospital for Children, Wilmington, DE, USA
| | - Magee L DeFelice
- Thomas Jefferson University, Philadelphia, PA, USA.
- Division of Allergy and Immunology, Nemours/AI duPont Hospital for Children, Wilmington, DE, USA.
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Abstract
Eosinophilic lung diseases especially comprise eosinophilic pneumonia or as the more transient Löffler syndrome, which is most often due to parasitic infections. The diagnosis of eosinophilic pneumonia is based on characteristic clinical-imaging features and the demonstration of alveolar eosinophilia, defined as at least 25% eosinophils at BAL. Peripheral blood eosinophilia is common but may be absent at presentation in idiopathic acute eosinophilic pneumonia, which may be misdiagnosed as severe infectious pneumonia. All possible causes of eosinophilia, including drug, toxin, fungus related etiologies, must be thoroughly investigated. Extrathoracic manifestations should raise the suspicion of eosinophilic granulomatosis with polyangiitis.
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35
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[Consortium for detection and management of lung damage induced by bleomycin]. Bull Cancer 2016; 103:651-61. [PMID: 27241272 DOI: 10.1016/j.bulcan.2016.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/15/2016] [Accepted: 04/18/2016] [Indexed: 11/21/2022]
Abstract
Bleomycin is a cytotoxic antibiotic and a component of chemotherapy regimens of germ cell tumors and lymphoma. Bleomycin lung injuries occur in 10% of patients, and lead to severe interstitial pneumonia in 3% of patients. Pulmonary toxicity is related to endothelial cells injury induce by free radicals and inflammatory cytokines. Diagnosis of bleomycin-induced lung toxicity is based on the combination of clinical and radiological features, and requires to rule out differential diagnoses including pneumocystis. "Bleomycin-induced pneumonitis" is the most frequent pattern; eosinophilic pneumonitis and organizing pneumonia are rarer. Occurrence of bleomycin lung toxicity requires an immediate and often permanent discontinuation. Treatment is based on steroid. Regular clinical and pulmonary function tests monitoring are mandatory for early detection of bleomycin-induced lung toxicity.
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36
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Manifestations subaiguës d’une pneumopathie hyperéosinophilique aux urgences. ANNALES FRANCAISES DE MEDECINE D URGENCE 2016. [DOI: 10.1007/s13341-016-0628-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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37
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Ishiguro T, Takayanagi N, Uozumi R, Baba Y, Kawate E, Kobayashi Y, Takaku Y, Kagiyama N, Shimizu Y, Morita S, Sugita Y. Diagnostic criteria that can most accurately differentiate allergic bronchopulmonary mycosis from other eosinophilic lung diseases: A retrospective, single-center study. Respir Investig 2016; 54:264-71. [PMID: 27424826 DOI: 10.1016/j.resinv.2016.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/20/2015] [Accepted: 01/27/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Several diagnostic criteria have been proposed to differentiate allergic bronchopulmonary mycosis (ABPM) from asthma, but there have been no studies to establish diagnostic criteria to classify ABPM differently from other eosinophilic lung diseases. METHODS We retrospectively investigated both patients with ABPM (n=42) diagnosed by clinical (Rosenberg-Patterson criteria modified to apply to fungi other than Aspergillus spp., with consideration of computed tomography and bronchoscopy findings) or pathological criteria and those with other eosinophilic lung diseases (n=118) to establish elaborate diagnostic criteria for ABPM. RESULTS Etiologies of ABPM included fungi other than Aspergillus spp. or unidentified pathogens in 16 patients. Fourteen patients (33.3%) did not have asthma. When the diagnostic cutoff line was set to satisfy six or more primary plus secondary modified Rosenberg-Patterson criteria, ABPM could be diagnosed with good sensitivity, specificity, and positive/negative predictive values (97.6%, 98.3%, 95.3%, and 99.1%, respectively). When the diagnostic criteria were combined with pathological criteria, the values further improved to 100%, 98.3%, 95.5%, and 100%, respectively. CONCLUSIONS Our results suggest that these novel criteria offer good sensitivity, specificity, and positive/negative predictive values for the diagnosis and classification of ABPM.
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Affiliation(s)
- Takashi Ishiguro
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya City, Saitama Pref. 360-0105, Japan.
| | - Noboru Takayanagi
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya City, Saitama Pref. 360-0105, Japan.
| | - Ryuji Uozumi
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Yuri Baba
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya City, Saitama Pref. 360-0105, Japan.
| | - Eriko Kawate
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya City, Saitama Pref. 360-0105, Japan.
| | - Yoichi Kobayashi
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya City, Saitama Pref. 360-0105, Japan.
| | - Yotaro Takaku
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya City, Saitama Pref. 360-0105, Japan.
| | - Naho Kagiyama
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya City, Saitama Pref. 360-0105, Japan.
| | - Yoshihiko Shimizu
- Department of Pathology, Saitama Cardiovascular and Respiratory Center, Saitama, Japan.
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Yutaka Sugita
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya City, Saitama Pref. 360-0105, Japan.
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Giovannini-Chami L, Blanc S, Hadchouel A, Baruchel A, Boukari R, Dubus JC, Fayon M, Le Bourgeois M, Nathan N, Albertini M, Clément A, de Blic J. Eosinophilic pneumonias in children: A review of the epidemiology, diagnosis, and treatment. Pediatr Pulmonol 2016; 51:203-16. [PMID: 26716396 DOI: 10.1002/ppul.23368] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/24/2015] [Accepted: 12/02/2015] [Indexed: 12/19/2022]
Abstract
Pediatric eosinophilic pneumonias (EPs) are characterized by a significant infiltration of the alveolar spaces and lung interstitium by eosinophils, with conservation of the lung structure. In developed countries, EPs constitute exceptional entities in pediatric care. Clinical symptoms may be transient (Löffler syndrome), acute (<1 month and mostly <7 days), or chronic (>1 month). Diagnosis relies on demonstration of alveolar eosinophilia on bronchoalveolar lavage, whether or not associated with blood eosinophilia. EPs are a heterogeneous group of disorders divided into: (i) secondary forms (seen mainly in parasitic infections, allergic bronchopulmonary aspergillosis, and drug reactions); and (ii) primary forms (eosinophilic granulomatosis with polyangiitis, hypereosinophilic syndrome, idiopathic chronic eosinophilic pneumonia, and idiopathic acute eosinophilic pneumonia). Despite their rarity, the etiological approach to EP must be well-defined as some causes can be rapidly life-threatening without initiation of the proper treatment. This approach (i) eliminates secondary forms, with comprehensive history taking and minimal biological assessment, (ii) is oriented in primary forms by the acute or chronic setting, and the existence of extrapulmonary symptoms. Treatment of primary forms has traditionally relied on corticosteroids, usually with a dramatic response. Specific treatments or the adjunction of corticosteroid-sparing treatment or immunosuppressors are currently being evaluated in order to improve the prognosis and the side effects associated with corticosteroid treatment in a pediatric setting.
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Affiliation(s)
- Lisa Giovannini-Chami
- Department of Pediatric Pulmonology and Allergology, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France.,Université de Nice Sophia Antipolis, Nice, France
| | - Sibylle Blanc
- Department of Pediatric Pulmonology and Allergology, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Alice Hadchouel
- Department of Pediatric Pulmonology, AP-HP, Hôpital Necker Enfants Malades, Paris, France.,Université Paris Descartes-Paris 5, Paris, France
| | - André Baruchel
- Department of Pediatric Hematology, AP-HP, Hôpital Robert Debré, Paris, France.,Université Paris Diderot VII, Paris, France
| | - Rachida Boukari
- Department of Pediatric Pulmonology, Centre Hospitalier Universitaire Mustapha, Alger, Algérie
| | - Jean-Christophe Dubus
- Department of Pediatric Pulmonology, Centre Hospitalier Universitaire de Marseille, Marseille, France
| | - Michael Fayon
- Department of Pediatric Pulmonology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Département de Pédiatrie, Centre d'Investigation Clinique, Bordeaux, France
| | - Muriel Le Bourgeois
- Department of Pediatric Pulmonology, AP-HP, Hôpital Necker Enfants Malades, Paris, France
| | - Nadia Nathan
- Department of Pediatric Pulmonology, AP-HP, Hôpital Trousseau, Paris, France.,Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Marc Albertini
- Department of Pediatric Pulmonology and Allergology, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France.,Université de Nice Sophia Antipolis, Nice, France
| | - Annick Clément
- Department of Pediatric Pulmonology, AP-HP, Hôpital Trousseau, Paris, France.,Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Jacques de Blic
- Department of Pediatric Pulmonology, AP-HP, Hôpital Necker Enfants Malades, Paris, France.,Université Paris Descartes-Paris 5, Paris, France
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Song JI, Kim YK, Hwang JH, Yang HJ. Early diagnosis based on clinical history and BALF for successful management of smoking-induced acute eosinophilic pneumonia without unnecessary antibiotic usage: a case report. J Asthma 2016; 53:452-5. [PMID: 26540020 DOI: 10.3109/02770903.2015.1101135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Acute eosinophilic pneumonia (AEP) is a rapid onset and severe respiratory illness characterized by acute febrile respiratory insufficiency, eosinophilic infiltration in the lungs and unique findings on chest imaging. Difficulty in differentiating from other respiratory distress caused by community-acquired pneumonia may result in a delayed diagnosis or treatment with empirical antibiotics. CASE STUDY Sixteen-year-old boy who developed AEP with marked eosinophilia in bronchoalveolar lavage fluid (BALF, 36.6%), decreased diffusion capacity of the lung for carbon monoxide (62%) and unique radiological findings. Although he initially denied tobacco use, on repeated thorough clinical history questioning, he eventually admitted beginning smoking 19 days before the onset of symptoms with gradually increasing frequency. RESULTS His symptoms resolved quickly without use of antibiotics after cessation of tobacco and treatment with corticosteroids. CONCLUSION Careful clinical history taking regarding tobacco use combined with early examination of BALF and recognition of unique radiological findings are critical for proper management of AEP.
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Affiliation(s)
| | - Yang-Ki Kim
- b Division of Respiratory and Allergy Medicine , Department of Internal Medicine , and
| | - Jung Hwa Hwang
- c Department of Radiology , Soonchunhyang University Hospital, Soonchunhyang University College of Medicine , Seoul , Korea
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40
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Choi JY, Kim JE, Choi IY, Lee JH, Kim JH, Shin C, Lee SH. Churg-Strauss syndrome that presented with mediastinal lymphadenopathy and calculous cholecystitis. Korean J Intern Med 2016; 31:179-83. [PMID: 26767873 PMCID: PMC4712424 DOI: 10.3904/kjim.2016.31.1.179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 03/09/2015] [Accepted: 03/16/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jung Yoon Choi
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Ji Eun Kim
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - In Young Choi
- Department of Radiology, Korea University Ansan Hospital, Ansan, Korea
| | - Ju Han Lee
- Department of Pathology, Korea University Ansan Hospital, Ansan, Korea
| | - Je Hyeong Kim
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Chol Shin
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Seung Heon Lee
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
- Correspondence to Seung Heon Lee, M.D. Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan 15355, Korea Tel: +82-31-412-4973 Fax: +82-31-412-5604 E-mail:
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41
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Lim JH, Nam HS, Kim HJ, Choi CH, Park IS, Cho JH, Ryu JS, Kwak SM, Lee HL. Migratory eosinophilic alveolitis caused by radiation therapy. J Thorac Dis 2015; 7:E117-21. [PMID: 26101656 DOI: 10.3978/j.issn.2072-1439.2015.05.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 04/10/2015] [Indexed: 11/14/2022]
Abstract
Although radiation pneumonitis is usually confined to irradiated areas, some studies have reported that radiation-induced lymphocytic alveolitis can also spread to the non-irradiated lung. However, there have been few reports of radiation-induced eosinophilic alveolitis. We report the case of a 27-year-old female with radiation pneumonitis, occurring 4 months after radiation therapy for cancer of the left breast. Clinical and radiological relapse followed withdrawal of corticosteroids. Examination of bronchoalveolar lavage (BAL) in patchy airspace consolidations revealed increased eosinophil counts. Finally, clinical and radiological signs resolved rapidly after reintroduction of corticosteroids. Eosinophilic alveolitis may be promoted by radiation therapy. In the present case report, possible mechanisms for radiation-induced eosinophilic alveolitis are also reviewed.
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Affiliation(s)
- Jun Hyeok Lim
- 1 Division of Pulmonology, Department of Internal Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Hae-Seong Nam
- 1 Division of Pulmonology, Department of Internal Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Hun Jung Kim
- 1 Division of Pulmonology, Department of Internal Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Chang-Hwan Choi
- 1 Division of Pulmonology, Department of Internal Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - In-Suh Park
- 1 Division of Pulmonology, Department of Internal Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Jae Hwa Cho
- 1 Division of Pulmonology, Department of Internal Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Jeong-Seon Ryu
- 1 Division of Pulmonology, Department of Internal Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Seung Min Kwak
- 1 Division of Pulmonology, Department of Internal Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Hong Lyeol Lee
- 1 Division of Pulmonology, Department of Internal Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
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Brackel CLH, Ropers FG, Vermaas-Fricot SFN, Koens L, Willems LNA, Rikkers-Mutsaerts ERVM. Acute eosinophilic pneumonia after recent start of smoking. Lancet 2015; 385:1150. [PMID: 25797559 DOI: 10.1016/s0140-6736(15)60128-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Caroline L H Brackel
- Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands.
| | - Fabienne G Ropers
- Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands
| | | | - Lianne Koens
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Luuk N A Willems
- Department of Pulmonology, Leiden University Medical Center, Leiden, Netherlands
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Oyama Y, Fujisawa T, Hashimoto D, Enomoto N, Nakamura Y, Inui N, Kuroishi S, Yokomura K, Toyoshima M, Yamada T, Shirai T, Masuda M, Yasuda K, Hayakawa H, Chida K, Suda T. Efficacy of short-term prednisolone treatment in patients with chronic eosinophilic pneumonia. Eur Respir J 2015; 45:1624-31. [DOI: 10.1183/09031936.00199614] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/08/2014] [Indexed: 12/28/2022]
Abstract
In patients with chronic eosinophilic pneumonia (CEP), dramatic improvements are seen in response to corticosteroid therapy; however, relapse is common after treatment has ceased. The optimal duration of corticosteroid therapy remains unclear.In a randomised, open-label, parallel group study, eligible patients with CEP received oral prednisolone for either 3 months (3-month group) or 6 months (6-month group), followed by 2 years observation. All patients were treated with an initial dose of prednisolone of 0.5 mg·kg−1·day−1, which was then tapered and discontinued at either 3 or 6 months. The primary end-point was relapse during the follow-up period.In the final analysis, there were 23 patients in the 3-month group and 21 patients in the 6-month group. All patients showed a good response to prednisolone treatment. There were 12 (52.1%) relapses in the 3-month group and 13 (61.9%) relapses in the 6-month group. No significant difference was found in the cumulative rate of relapse (p=0.56). All relapse cases showed improvement upon resumption of prednisolone treatment.No difference was observed in the rate of relapse between the 3- and 6-month prednisolone treatment groups for patients with CEP.
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Acute Pneumonia. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7151914 DOI: 10.1016/b978-1-4557-4801-3.00069-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Reesi MA, Al-Maani A, Paul G, Al-Arimi S. Primary Cytomegalovirus-Related Eosinophilic Pneumonia in a Three-year-old Child with Acute Lymphoblastic Leukaemia: Case report and literature review. Sultan Qaboos Univ Med J 2014; 14:e561-e565. [PMID: 25364562 PMCID: PMC4205071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 03/01/2014] [Accepted: 04/03/2014] [Indexed: 06/04/2023] Open
Abstract
A diagnosis of eosinophilic pneumonia (EP) is rare in patients with acute lymphoblastic leukaemia (ALL). We report a case of EP in association with a primary cytomegalovirus (CMV) infection in a three-year-old Omani child with ALL. The patient presented with fever while undergoing maintenance chemotherapy. He was admitted to the Child Health Department of Royal Hospital, in Muscat, Oman, in November 2011. He was initially thought to have sepsis but failed to respond to antibiotics. Chest computed tomography showed diffuse ground glass lung opacification. Bronchoalveolar lavage (BAL) cytology was consistent with the diagnosis of EP. Polymerase chain reaction tests for CMV were performed on the BAL and blood samples and were both markedly elevated. The patient made a full recovery after treatment with prednisolone and ganciclovir. The association between CMV infection and EP as well as the management of this combination in immunocompromised patients has never been reported in the English literature.
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Affiliation(s)
| | - Amal Al-Maani
- Department of Child Health, Royal Hospital, Muscat, Oman
| | - George Paul
- Department of Child Health, Royal Hospital, Muscat, Oman
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Ekin S, Sertogullarindan B, Gunbatar H, Arisoy A, Yildiz H. Loeffler's syndrome: an interesting case report. CLINICAL RESPIRATORY JOURNAL 2014; 10:112-4. [PMID: 24931460 DOI: 10.1111/crj.12173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 04/17/2014] [Accepted: 06/09/2014] [Indexed: 11/30/2022]
Abstract
Loeffler's syndrome is an acute pneumonia with an unclear cause. One fourth of Loeffler's syndrome patients are idiopathic, although the most common etiologic causes include parasites. Asymptomatic form is usually a reversible, self-limited disease, which does not require a specific treatment regimen. We presented a 17-year-old young man with diagnosis of Loeffler syndrome.
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Affiliation(s)
- Selami Ekin
- Medical Faculty, Department of Pulmonary and Critical Care, Yuzuncu Yil University, Van, Turkey
| | | | - Hulya Gunbatar
- Medical Faculty, Department of Pulmonary and Critical Care, Yuzuncu Yil University, Van, Turkey
| | - Ahmet Arisoy
- Department of Pulmonary and Critical Care, Private Istanbul Hospital, Van, Turkey
| | - Hanifi Yildiz
- Department of Pulmonary and Critical Care, Van Teaching and Research Goverment Hospital, Van, Turkey
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48
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Tsuge I, Ito K, Ohye T, Kando N, Kondo Y, Nakajima Y, Inuo C, Kurahashi H, Urisu A. Acute eosinophilic pneumonia occurring in a dedicator of cytokinesis 8 (DOCK8) deficient patient. Pediatr Pulmonol 2014; 49:E52-5. [PMID: 24106060 DOI: 10.1002/ppul.22814] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 03/28/2013] [Indexed: 11/11/2022]
Abstract
Dedicator of cytokinesis 8 (DOCK8) deficiency is an autosomal recessive type of combined immunodeficiency with elevated IgE. In this report, we describe a Japanese girl of non-consanguineous family suffering from acute eosinophilic pneumonia (AEP) as a presenting feature of DOCK8 deficiency. Although AEP was self-limiting, consecutively experienced recurrent respiratory infections, severe atopic dermatitis, and vulnerability to viral infections, prompted us to evaluate the possibility of DOCK8 deficiency. Immunological assessments demonstrated decreased IgM, increased IgE, T lymphocytepenia, especially in CD4 T cells, decreased PHA blastogenesis, and decreased CD27(+) CD19(+) memory B cells. Western blotting revealed the absence of DOCK8 protein. Investigation of genomic DNA by multiplex ligation-dependent probe amplification (MLPA) revealed a heterozygous large deletion of 77 kb spanning from intron 5 to exon 22. DOCK8 cDNA sequencing revealed a nonsense mutation at position 740 (E740X). As far as we know, this is the first Japanese case of DOCK8 deficiency.
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Affiliation(s)
- Ikuya Tsuge
- Department of Pediatrics, Fujita Health University, Toyoake, Aichi, Japan
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Griffiths CL, Gutierrez KC, Pitt RD, Lovell RD. Eosinophilic pneumonia induced by ceftaroline. Am J Health Syst Pharm 2014; 71:403-6. [PMID: 24534595 DOI: 10.2146/ajhp130441] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE A case of eosinophilic pneumonia in a patient receiving ceftaroline for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is reported. SUMMARY A 65-year-old woman was admitted to a medical intensive care unit after arriving at the emergency room with complaints of progressively worsening shortness of breath. Her medical history included chronic obstructive pulmonary disease, acute respiratory distress syndrome, recent traumatic brain injury, tobacco use, and alcohol abuse. Within the first few days of hospitalization, the patient was diagnosed with MRSA pneumonia based on microbiological data from bronchoscopy bronchial washings. Her renal function liver enzyme levels were within normal limits. Empirical antibiotic therapy included i.v. vancomycin and meropenem and was narrowed to i.v. linezolid monotherapy based on culture and sensitivity results. After 10 days of treatment with linezolid, the patient was persistently febrile, and cultures remained positive. It was decided to switch therapy to a course of i.v. ceftaroline, an anti-MRSA cephalosporin. On the fifth day of treatment with ceftaroline, the patient developed respiratory decompensation and peripheral eosinophilia of 40%. Bronchoalveolar lavage (BAL) results indicated the presence of pulmonary eosinophilia of 13%. Chest radiographs revealed pulmonary infiltrates, and the computed tomography angiography showed no evidence of pulmonary embolism. Ceftaroline was discontinued, and the patient was started on vancomycin and methylprednisolone. The patient responded to methylprednisolone therapy, with repeat BAL and peripheral blood counts showing resolved eosinophilia. CONCLUSION A patient with risk factors for respiratory disease developed eosinophilic pneumonia after receiving ceftaroline for the treatment of MRSA pneumonia. Eosinophilia resolved after ceftaroline was discontinued and i.v. methylprednisolone was initiated.
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Affiliation(s)
- Carrie L Griffiths
- Carrie L. Griffiths, Pharm.D., is Assistant Professor, Pharmacist, Wingate University School of Pharmacy (WUSOP), Wingate, NC, and Critical Care Clinical Pharmacist, Department of Pharmacy, Carolinas Medical Center, Charlotte, NC. Kristofer C. Gutierrez is Pharm.D. student; and Renee D. Pitt is Pharm.D. student, WUSOP. Roger D. Lovell, M.D., FACP, is Infectious Disease Physician and Clinical Professor, Department of Internal Medicine, University of North Carolina School of Medicine, Charlotte
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Giovannini-Chami L, Hadchouel A, Nathan N, Brémont F, Dubus JC, Fayon M, Houdouin V, Berlioz-Baudoin M, Feret V, Leblanc T, Morelle K, Albertini M, Clement A, de Blic J. Idiopathic eosinophilic pneumonia in children: the French experience. Orphanet J Rare Dis 2014; 9:28. [PMID: 24555756 PMCID: PMC3937523 DOI: 10.1186/1750-1172-9-28] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/07/2014] [Indexed: 01/29/2023] Open
Abstract
Background Idiopathic eosinophilic pneumonia is extremely rare in children and adults. We present herein the first series describing the specificities of idiopathic chronic (ICEP) and acute (IAEP) eosinophilic pneumonia in children. Methods We retrospectively analyzed all cases of ICEP and IAEP in children that were retrieved from French Reference Centers for rare pediatric lung diseases. Results Five cases of pediatric ICEP were identified. Corticosteroid or immunosuppressive therapy dramatically improved the outcome in three cases. The remaining two cases had a persistent interstitial pattern with progressive development of cystic airspace lesions. Three cases of IAEP in adolescents were reported, with one requiring four days of extracorporeal membrane oxygenation. Conclusion ICEP is a rare disease with a polymorphic clinical presentation in children. We identified patients with persistent interstitial patterns progressing to cystic airspace regions, for which the boundaries with idiopathic interstitial pneumonias are difficult to establish. We therefore propose a specific pediatric definition and classification algorithm. IAEP in children remains an inflammatory reaction of the lung to an acute toxic exposure, mainly tobacco, as in adults. International studies are required to comprehensively assess the various clinical forms of the disease as well as the appropriate therapeutic regimens.
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Affiliation(s)
- Lisa Giovannini-Chami
- Pediatric Pulmonology and Allergy Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice F-06200, France.
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