Transcript Radiology - UNC School of Medicine

Radiology
08/12/2009
08/25/2009
Radiology
08/12/2009
08/26/2009
Eosinophilic Lung Disease:
A case of drug-induced eosinophilic
pneumonitis.
Eldesia Granger
March 2, 2010
MP-2
Eosinophilic Lung Disease

Definition: a heterogeneous group of disorders
defined by increased numbers of eosinophils
within the pulmonary parenchyma.
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Defining characteristics:
 Peripheral blood eosinophilia with radiographically identified
pulmonary abnormalities.
 Lung parenchyma eosinophilia demonstrated in
transbronchial or open lung biopsies .
 Increased eosinophils in bronchoalveolar lavage (BAL) fluid
Eosinophilic Lung Disease: Differential
Diagnosis: Primary Causes
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Primary (Idiopathic)
 Churg–Strauss syndrome: necrotizing vasculitis
affecting small to medium sized vessels associated with
granulomatous inflammation involving the respiratory tract
asthma, allergic rhinitis, and eosinophilia
 Hypereosinophilic
syndromes: a group of disorders
marked by the sustained overproduction of eosinophils, in
which eosinophilic infiltration and mediator release cause
damage to lung, sinuses, nervous system, gastrointestinal
tract, kidney, and heart .
Eosinophilic Lung Disease: Differential
Diagnosis: Primary Causes
Acute Idiopathic Eosinophilic
Pneumonia
 Usually less than 2 weeks
 Increased risk for smokers
 Male:female 1: 1
 Absent or low blood
esosinophilia
 Severe hypoxemia
 Diffuse alveolointerstitial
pattern
Chronic: Idiopathic
Eosinophilic Pneumonia
 > 1 month
 h/o asthma
 Mild respiratory distress
 Marked blood eosinophilia
 ESR and CRP increased
 Elevated IgE
 Male: female 1:2
Eosinophilic Lung Disease: Differential
Diagnosis: Secondary Causes
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Secondary
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Eosinophilic pneumonias of
parasitic origin
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Tropical eosinophilia.
Ascaris pneumonia
Larva migrans syndrome
Strongyloides stercoralis infection
Allergic bronchopulmonary
aspergillosis and related fungal
syndromes
Drug, toxic agents and radiationinduced.
Evaluation of Pulmonary
Eosinophilia

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History: Medication, Travel, Toxin Exposures, Extra-pulmonary
symptoms
Blood eosinophilia
Radiological Imaging with High Res. CT
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Bronchoscopy
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Johkoh et al found that the three eosinophilic lung diseases that could be
diagnosed with greatest certainty were CEP, ABPA and AEP
>25% of BAL fluid is highly suggestive of pulmonary eosinophilia
Serologies
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CEP can occur in association with collagen vascular disease, vasculitis,
rheumatoid arthrities, scleroderma, Ulcerative colitis, breast cancer, and
other neoplasms.
Drug-Induced Eosinophilic
Pneumonitis

Definition: Diagnosis of exclusion. Documentation of drug
known to cause pulmonary eosinophilia. Rapid resolution with
withdrawal of the drug and/or steroid initiation.
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Incidence: Currently unknown. Estimated 100-500 cases/year.
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Well known epidemics:
1. L-tryptophan Eosinophila Myalgia Syndrome: 1989
2. Spanish Toxic Oil Syndrome 1981
Mechanism of Action
Offending Agents
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Commonly reported
1. nitrofurantoin
2. gold salts
3. captopril
4. minocycline
5. NSAIDs
6. methotrexate
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Occasionally reported
1. captopril
2. sulfonamides
3. GM-CSF
Rarely reported
1. Dapsone
2. chloroquine
3. diclofenac
4. erythromycin
5. INH
6. NSAIDS
7. Pyrimethamine
8. ethambutol
Drug-Induced Eosinophilic
Pneumonitis
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Treatment
1. withdrawal of offending agent
2. high dose steroids
Our patient
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Started on high dose steroids.
Peripheral Eosinophilia resolved in 24 hours.
ABG showed resolved hypoxia
Patient was discharged home on steroid taper.
Suggested offending meds: minocycline,
NSAIDS.
Resources
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Allen JN ET AL. Drug-induced eosinophilic lung disease CLINICS IN CHEST
MEDICINE 2004; 25: 77
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Cottin, V, Cordier, JF. Eosinophilic pneumonias. ALLERGY 2005; 60:841.
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Janz DR, O'Neal HR et al. Acute eosinophilic pneumonia: A case report and review
of the literature . CRITICAL CARE MEDICINE APR 2009; 37:1470-1474.
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Johkoh, T, Müller, NL, Akira, M, et al. Eosinophilic lung diseases: Diagnostic accuracy
of thin-section CT in 111 patients. Radiology 2000; 216:773.

Katz U, Shoenfeld Y. Pulmonary eosinophilia CLINICAL REVIEWS IN ALLERGY
& IMMUNOLOGY 2008; 34: 367-371

Klion A Hypereosinophilic Syndrome: Current Approach to Diagnosis and Treatment.
ANNUAL REVIEW OF MEDICINE 2009; 60: 293-306.
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Uptodate.com
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UNC pharmacy
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UNC Pulmonary