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Choo CYW, Wong KS, Lai SH, Chiu CC, Chiu CY. Diagnostic pitfalls of acute eosinophilic pneumonia in an adolescent boy following cigarette smoking: A case report. Medicine (Baltimore) 2019; 98:e15590. [PMID: 31096462 PMCID: PMC6531086 DOI: 10.1097/md.0000000000015590] [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] [Indexed: 11/09/2022] Open
Abstract
RATIONALE Acute eosinophilic pneumonia (AEP) is characterized by acute febrile respiratory symptoms, bilateral lung infiltrates, and pulmonary eosinophilia. AEP is closely related to cigarette smoking but is rarely suspected in pediatric cases despite the fact that there is a relatively high incidence of cigarette smoking among adolescents in Taiwan. PATIENT CONCERNS We report a case of a previously healthy 15-year-old boy who presented with fever and acute progressive dyspnea. Due to lack of awareness of cigarette smoking history in adolescents and the nonspecific signs and symptoms of AEP at early stages, the patient was initially treated as community-acquired pneumonia (CAP) but was unresponsive to antibiotics treatment. DIAGNOSES A combination of a recent onset smoking history and pulmonary eosinophilia on bronchoalveolar lavage confirmed the diagnosis of cigarette-induced AEP. INTERVENTIONS Corticosteroid treatment was prescribed. OUTCOMES The condition improved within 24 hours, with resolution of alveolar infiltrates on chest radiographs. LESSONS With the increasing incidence of smoking amongst adolescents in Taiwan, careful history questioning regarding cigarette smoking is necessary. Due to similarities in initial clinical and radiographic features of AEP and CAP, adolescents with suspected CAP who are unresponsive to antibiotic treatment but have a subsequent rise in peripheral eosinophils should raise the clinician's suspicion of AEP related to cigarette smoking.
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Affiliation(s)
| | - Kin-Sun Wong
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou
| | - Shen-Hao Lai
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou
| | - Chun-Che Chiu
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou
| | - Chih-Yung Chiu
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, and Chang Gung University, Taoyuan, Taiwan
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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: 24] [Impact Index Per Article: 3.0] [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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Buelow BJ, Kelly BT, Zafra HT, Kelly KJ. Absence of Peripheral Eosinophilia on Initial Clinical Presentation Does Not Rule Out the Diagnosis of Acute Eosinophilic Pneumonia. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:597-8. [PMID: 25683924 DOI: 10.1016/j.jaip.2015.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 01/12/2015] [Accepted: 01/12/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Becky J Buelow
- Division of Allergy, Asthma, and Clinical Immunology, Children's Hospital of Wisconsin, Department of Pediatrics, Milwaukee, Wis; Medical College of Wisconsin, Milwaukee, Wis.
| | - Brian T Kelly
- Division of Allergy, Asthma, and Clinical Immunology, Children's Hospital of Wisconsin, Department of Pediatrics, Milwaukee, Wis; Medical College of Wisconsin, Milwaukee, Wis
| | - Heidi T Zafra
- Division of Allergy, Asthma, and Clinical Immunology, Children's Hospital of Wisconsin, Department of Pediatrics, Milwaukee, Wis; Medical College of Wisconsin, Milwaukee, Wis
| | - Kevin J Kelly
- Division of Allergy/Immunology, Department of Pediatrics, University of North Carolina-Chapel Hill, NC
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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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Amiconi S. How are Eosinophils Supplied from Bone Marrow to Eosinophil-Infiltrated Tissues, When Blood Eosinophilia is Not Observed? The Case of Acute Eosinophilic Pneumonia. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:349-50. [PMID: 25077086 PMCID: PMC4114015 DOI: 10.4103/1947-2714.136925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Simona Amiconi
- Department of Anesthesia and Critical Care, Schwabing Hospital, Munich, Germany E-mail:
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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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Amiconi S, Hirl B. A combination of predispositions and exposures as responsible for acute eosinophilic pneumonia. Multidiscip Respir Med 2014; 9:7. [PMID: 24475879 PMCID: PMC3909902 DOI: 10.1186/2049-6958-9-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/15/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Acute eosinophilic pneumonia (AEP) is a rare febrile illness which is characterized by respiratory failure and often requires mechanical ventilation. The causes and sequence of events of this disease at a biochemical and histological level remain largely unknown. In this article we report the exceptional case, possibly unique, of a patient who developed AEP and three pneumothoraces within less than one month during her hospitalization. CASE PRESENTATION A 39-year-old German woman was admitted to our hospital for a laparoscopy-assisted vaginal hysterectomy under general anaesthesia. The surgical intervention was followed by peritonitis in the early postoperative course. Following anaesthesia induction with propofol/midazolam and during the prolonged therapy with several broad-spectrum antibiotics, she developed AEP and three spontaneous (one left-sided and two right-sided) pneumothoraces, the latter ones observed in quick succession. Symptoms, laboratory markers, and chest radiology significantly improved after a one-day treatment with methylprednisolone. CONCLUSIONS On the whole, these pathological occurrences, together with similar cases reported in literature, can support the conclusion of possible predisposing genetic factors at the lung tissue level of AEP patients, a view that might shed new light on the pathogenesis of this disease. To provide a coherent pattern that explains the reported evidence for AEP and pneumothoraces, independently from the causative stimulus, the supposed molecular mutations could be localized in the connective tissue rather than in the epithelial cells. In order to interpret clinical and laboratory evidence, as well as to support the main conclusions, the important part of scientific research here presented can also assist physicians in making more informed decisions for the treatment of patients with pulmonary infiltrates.
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Affiliation(s)
- Simona Amiconi
- Department of Anesthesia and Critical Care, Schwabing Hospital, Munich 80804, Germany
| | - Bertrand Hirl
- Department of Anesthesia and Critical Care, Schwabing Hospital, Munich 80804, Germany
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