Transcript Pulmonary Infiltrates with Eosinophilia Hassan Ghobadi MD

Pulmonary Infiltrates
with Eosinophilia
Hassan Ghobadi MD
Assistant professor of Internal Medicine
Ardabil University of Medical Science
Introduction
PIE, Eosinophilic pneumonias include
syndromes characterized by eosinophilic
pulmonary infiltrates and, commonly,
peripheral blood eosinophilia.
This group of disorders has been classified to:
1- Known etiology
2- Unknown etiology
PIE Syndrome
Drug-induced eosinophilic pneumonias are
the most common cause of eosinophilic
pulmonary infiltrates.
Treatment consists of withdrawal of the
incriminated drugs and the use of
glucocorticoids, if necessary.
Pulmonary Infiltrates with
Eosinophilia
 Etiology Known
1- Allergic bronchopulmonary mycoses
2- Parasitic infestations
3- Drug reactions
4- Eosinophilia-myalgia syndrome
 Etiology Unknown
1- Loeffler's syndrome
2- Acute eosinophilic pneumonia
3- Chronic eosinophilic pneumonia
4- Allergic granulomatosis of Churg and Strauss
5- Hypereosinophilic syndrome
Allergic bronchopulmonary
aspergillosis
 When an eosinophilic pneumonia is associated with atopic asthma,
and has skin reactivity to Aspergillus.
 If so, other criteria should be sought for the diagnosis of allergic
bronchopulmonary aspergillosis (ABPA) .
 The chest roentgenogram in ABPA may show transient, recurrent
infiltrates or may suggest the presence of proximal bronchiectasis .
 High-resolution chest CT is a sensitive, noninvasive technique for
the recognition of proximal bronchiectasis.
 Adequate treatment usually requires the long-term use of systemic
glucocorticoids.
Diagnostic Features of ABPA
Main Diagnostic Criteria
1- Bronchial asthma
2- Pulmonary infiltrates
3- Peripheral eosinophilia (>1000/ L)
4- Immediate wheal-and-flare response to Aspergillus fumigatus
5- Serum precipitins to A. fumigatus
6- Elevated serum IgE
7- Central bronchiectasis
Other Diagnostic Features
1- History of brownish plugs in sputum
2- Culture of A. fumigatus from sputum
3- Elevated IgE (and IgG) class antibodies specific for A. fumigatus
Pulmonary Infiltrates with
Eosinophilia
 Acute eosinophilic pneumonia is an idiopathic acute febrile
illness of < 7 days' duration with severe hypoxemia,
pulmonary infiltrates, and no history of asthma.
 Chronic eosinophilic pneumonia presents with significant
systemic symptoms including fever, chills, night sweats,
cough, anorexia, and weight loss of several weeks' to
months' duration.
 The chest x-ray classically shows peripheral infiltrates.
 Dramatic clearing of symptoms and chest x rays is often
noted within 48 h after initiation of glucocorticoid therapy .