107 Eosinophilic Pneumonia

Clinical Presentation

43-year-old woman undergoing treatment for rheumatoid arthritis presents with dry cough and pleuritic chest pain

Radiologic Findings

PA chest radiograph (Fig. 107.1) demonstrates bilateral asymmetric peripheral upper lobe predominant consolidations, more pronounced in the right upper lobe. Contrast-enhanced chest CT (lung window) (Figs. 107.2, 107.3) shows bilateral peripheral nodular non-segmental consolidations with intrinsic air bronchograms affecting predominantly the upper lobes. The symptoms and radiographic abnormalities resolved after a change in drug therapy was instituted.

Diagnosis

Eosinophilic Pneumonia

Differential Diagnosis

• Infection (tuberculosis, other bacteria)

• Cryptogenic Organizing Pneumonia (COP)

• Multicentric Adenocarcinoma

• Pulmonary Lymphoma

Fig. 107.1

Fig. 107.2

Fig. 107.3

Discussion

Background

Eosinophilic lung diseases are a diverse group of disorders characterized by pulmonary abnormalities associated with peripheral blood eosinophilia, tissue eosinophilia, and/or increased eosinophils in bronchoalveolar lavage (BAL) fluid.

Etiology

Eosinophilic pneumonias can be divided into diseases of unknown etiology and those of known causes. The former include simple (Loeffler syndrome), acute, and chronic eosinophilic pneumonias and idiopathic hypereosinophilic syndrome. Eosinophilic lung diseases of known cause include allergic bronchopulmonary fungal disease (typically aspergillosis), bronchocentric granulomatosis, parasitic infections, and eosinophilic lung disease secondary to drug reaction. Eosinophilic vasculitides include Churg-Strauss syndrome and allergic angiitis. In addition, several other diseases are associated with eosinophilia, including asthma, various infections, neoplasms, and collagen vascular disorders. Specific diseases that may produce minor eosinophilia include rheumatoid arthritis, Wegener granulomatosis, idiopathic pulmonary fibrosis, and pulmonary Langerhans’ cell histiocytosis.