Only recently, unsuspected xray evidence of nondescript pulmonary infiltrations has focused attention on loefflers syndrome, tropical eosinophilia and related conditions. Nonsteroidal antiinflammatory drugassociated pulmonary. The chest radiograph showed unilateral alveolointerstitial infiltrates and a biopsy specimen of the lung parenchyma showed changes consistent with. Eosinophils are a type of white blood cell and are part of the immune system. Asthma may manifest with marked eosinophilia, with or without infiltrates. Pulmonary infiltrates, eosinophilia, and cardiomyopathy. A variety of drugs has been implicated as causes of pulmonary infiltrates with peripheral eosinophilia. Guideline for the investigation and management of eosinophilia. Pulmonary infiltrates with eosinophilia pie, also called eosinophilic pneumonia, is a syndrome associated with a variety of clinical entities, only some of which have an infectious cause. Pulmonary infiltrate with eosinophilia diseases of the chest.
Aep was first described in 1989 4, 5 as an acute febrile illness, presenting with diffuse pulmonary infiltrates and acute respiratory failure, characterized by bal eosinophilia and prompt clinical improvement after corticosteroid therapy. Eosinophilia, respiratory symptoms and pulmonary infiltrates in rubber workers. Hypersensitivity pneumonitis and pulmonary infiltrates. The case history is described of an elderly man with rheumatoid arthritis receiving treatment with sulfasalazine and the cyclooxygenase2 inhibitor celecoxib who presented with severe shortness of breath, cough, and decreased exercise tolerance. Pulmonary infiltrates and eosinophilia revisited cleveland. Eosinophilic lung disease radiology reference article. Eosinophilic lung diseases are a heterogeneous group of disorders that share the feature of abnormally increased numbers of eosinophils within the pulmonary airways and parenchyma. Increased use of chest roentgenography and expanded mass xray. Here we report a case of lymphoma accompanied with pulmonary infiltrates and clinical feature of eosinophilia. Loeffler, in 1932, first described the syndrome now associated with his name, characterized by transient pulmonary infiltrate and high eosinophil counts in the. It has been emphasized that this is a mild respiratory illness of short duration. Clarithromycin and pulmonary infiltration with eosinophilia.
The pulmonary infiltrates with eosinophilic syndrome comprise a spectrum of clinical manifestations characterized by peripheral eosinophilia and eosinophilic pulmonary infiltrates but is. Define pulmonary infiltration with eosinophilia pie. Pulmonary infiltration with eosinophilia definition of. Eosinophilia and pulmonary infiltrates have been reported in patients with aids, lymphoma, a variety of inflammatory lung diseases, and collagen vascular diseases see causes. Early classification schemes viewed these syndromes as a continuum with significant overlap between categories. Blood and bal eosinophilia xixc may suffice to secure the diagnosis without recourse to the lung biopsy. Pulmonary infiltrate with eosinophilia definition of.
Jun 19, 2003 pulmonary diseases induced by drugs include bronchial asthma, pulmonary infiltration with eosinophilia, diffuse fibrosing alveolitis, vasculitis, and pleural diseases. Allergic bronchopulmonary aspergillosis abpa is a hypersensitivity pulmonary disease occurring in individuals with asthma or cystic fibrosis. Pulmonary infiltrate with eosinophilia report of a case robert g. Dec 31, 2015 pulmonary diseases associated with tissue andor blood eosinophilia are a heterogeneous group of disorders. Overview of eosinophilic pulmonary diseases pulmonary. Eosinophilic lung diseases are a diverse group of pulmonary disorders associated with.
Acute eosinophilic pneumonia is a syndrome characterized by fevers, acute respiratory failure that often requires mechanical ventilation, diffuse pulmonary infiltrates, and pulmonary eosinophilia in a previously healthy individual table 3103. Hypereosinophilic syndrome in the differential diagnosis of. A peripheral and pulmonary eosinophilia was detected in both dogs. Pulmonary infiltration and eosinophilia englishgerman. Simple pulmonary eosinophilia spe simple pulmonary eosinophilia also known as loffler syndrome is a benign and selflimiting condition, characterized by mild symptoms and plain radiographic findings usually much more impressive than the patients condition, and classically have a reverse bats wing appearance. Chest xray usually shows abnormal shadows called infiltrates. Asthma is often accompanied by peripheral eosinophilia and eosinophilic airway inflammation. Allergic bronchopulmonary aspergillosis an overview. Fewer than 25 case reports of loefflers syndrome were found by peabody 1 in english as recently as 1944. Dramatic relief of clinical signs, radiographic infiltrate and peripheral eosinophilia occurred after administration of. Di pie may manifest with fever, dyspnea and wheezes. Eosinophilia with pulmonary infiltrates is an uncommon clinical characteristic of diffuse lung disease, in particular if the hypothetical cause is. Cardiopulmonary and gastrointestinal manifestations of. We report five unique cases of asthmainduced shortterm eosinophilic pneumonia encountered at our pulmonary and critical care centre in hunan.
Fungal infections associated with pulmonary infiltrates and eosinophilia include aspergillus infections, coccidioides immitis infections, and other less common infections aspergillus infections. Known causes of eosinophilic pulmonary disease include. A diagnosis of loefflers syndrome had been entertained, but it was felt that the patient was deteriorating too progressively for this supposedly benign disease. Although eosinophilia has been considered a constant finding, it is only observed in about 7080% of cases. Nonresolving and slowly resolving pneumonias are the most common broad categories of persistent pulmonary infiltrate. Pulmonary infiltrates and eosinophilia from minocycline. Pulmonary infiltrates with eosinophilia syndromes in.
Pulmonary infiltration with eosinophilia wikivet english. Ho et al1 described two patients in whom administration of a tetracycline antibiotic was associated with diffuse skin rash and pulmonary infiltrates with eosinophilia. Clarithromycin and pulmonary infiltration with eosinophilia article pdf available in bmj british medical journal january 2003 with 68 reads how we measure reads. Although understanding of certain of these syndromes has increased, this classification system remains a useful framework for identification. Simple pulmonary eosinophilia spe, also known as loeffler syndrome, is a rare, temporary transient respiratory disorder characterized by the accumulation of eosinophils in the lungs pulmonary eosinophilia. After discontinuation of montelukast therapy and administration of systemic corticosteroids the patients symptoms reversed rapidly and there was prompt resolution of the pulmonary. The hypereosinophilic syndrome is a group of diseases characterized by persistent blood eosinophilia, defined as more than 1500 cells per microliter with endorgan involvement and no recognized. Pulmonary eosinophilia comprises a wideranging and heterogeneous group of diseases defined by eosinophilia in pulmonary infiltrates bronchoalveolar lavage fluid or in tissue lung biopsy specimens and is often accompanied by increased peripheral blood eosinophilia 79, including asthma, chronic urticaria, chronic eosinophilic pneumonia. Pulmonary infiltrates and eosinophilia in a 25yearold traveler. In these patients, it is characterized by transient pulmonary infiltrates, reversible airway obstruction, eosinophilia, and evidence of hypersensitivity to the fungus. Pulmonary hypereosinophilia annals academy of medicine. The differential diagnosis of pulmonary eosinophilia is broad and. Jan, 2014 eosinophilia with pulmonary infiltrates is an uncommon clinical characteristic of diffuse lung disease, in particular if the hypothetical cause is lymphoma accompanied with infection of epsteinbarr eb virus. Acute eosinophilic pneumonia in a new york city firefighter exposed to world trade center dust.
Tropical eosinophilia is considered a manifestation of a species of microfilaria. In onethird of patients, the cause is unknown, while in others it may be secondary to an underlying parasitic infection or drug. Pulmonary infiltration with eosinophilia pie definition. Loefflers syndrome and pulmonary infiltrations accompanied by peripheral eosinophilia. Allergy rounds pulmonary infiltrates with eosinophilia jaci. The spectrum of eosinophilic lung diseases comprises a diverse group of pulmonary disorders that have an association with tissue or peripheral eosinophilia.
Pulmonary eosinophilia associated with montelukast thorax. Pulmonary eosinophilia developed while he was receiving treatment with montelukast, a chemically distinct cysteinyl leukotriene type 1 receptor antagonist. Hypersensitivity pneumonitis hp, also referred to as extrinsic allergic alveolitis, is a pulmonary disease that occurs due to inhalational exposure to a variety of antigens leading to an inflammatory response of the alveoli and small airways. Other causes include lupus pneumonitis, 1 cocaine smoking, 2 bronchiolitis obliterans with organising pneumonia, radiation pneumonitis, vasculitic syndromes including wegeners granulomatosis, and many of the pulmonary eosinophilic syndromes. Pdf pulmonary infiltrates with eosinophiliaallergic. Simple pulmonary eosinophilia nord national organization. Spontaneous resolution of eosinophilia without treatment may be due to removal of an offending agent ie, transient exposure, clearance of an infection, andor downregulation of host responses eg, with chronic helminth infection. Although we cannot dismiss this possibility, with the detection of this unusual cluster of cases of eosinophilia, pulmonary infiltrates, and cardiomyopathy due to the increased vigilance known to accompany the introduction of a new drug, the incidence of such a syndrome would be extremely high. Sir william osler 2 was probably first to report pulmonary abnormality associated with allergic disease.
What is pulmonary infiltration with eosinophilia pie. Pulmonary infiltration with eosinophils in 14 dogs. Pulmonary infiltration with eosinophilia pie is a broad term describing an inflammatory lung disease in which the predominant infiltrating cell is the eosinophil. Pulmonary opacities on chest xray associated with blood eosinophilia are sometimes called pie pulmonary infiltrates with eosinophilia syndrome. There is a case report of ethambutolinduced pulmonary infiltrates with eosinophilia and a skin reaction. Pulmonary infiltrates are frequently migratory, and iron deficiency anemia may occur. Although technically not an infection because it is the host response to. After eight weeks of therapy she developed a blood eosinophilia with pulmonary infiltrates and a skin rash. Pdf pulmonary eosinophilic infiltrates researchgate. Meaning of pulmonary infiltration with eosinophilia pie medical term. We propose that tetracycline may be another causative agent associated with the syndrome of pulmonary infiltrates witheosinophilia pie. This report describes a spectrum of respiratory illnesses associated with eosinophilia which occurred in a group of workers exposed to fumes from a synthetic rubberbased curing operation. Pulmonary infiltrates with eosinophilia or pie syndromes are a heterogeneous group of disorders characterized by eosinophilic infiltration of the lung parenchyma.
Pulmonary infiltrates with eosinophilia syndromes in children. Abstractdiseases characterized by pulmonary infiltrates and peripheral eosinophilia have been grouped based on a common clinical presentation. Pulmonary eosinophil infiltrates in lung biopsy specimens present. The category of myeloidlymphoid neoplasms with eosinophilia and rearrangement of pdgfra, pdgfrb, fgfr1 and pcm1jak2 represents an uncommon cause of eosinophilic lung infiltrate. Tropical pulmonary eosinophilia is a rare, but well recognised, syndrome characterised by pulmonary interstitial infiltrates and marked peripheral eosinophilia. Pulmonary infiltrates with eosinophilia associated with. Infections, drugs, allergens, toxic agents have to be evaluated as possible causes of eosinophilic lung infiltrates. Eosinophilia with pulmonary infiltrates is an uncommon clinical characteristic of diffuse lung disease, in particular if the hypothetical cause is lymphoma accompanied with infection of epsteinbarr eb virus. Diseases characterized by pulmonary infiltrates and peripheral eosinophilia have been grouped based on a common clinical presentation. The objective of this guideline is to provide healthcare professionals with clear guidance on the investigation and management of eosinophilia.
Various nosologies have been offered, but this article classifies these syndromes as extrinsic or intrinsic in origin. Shortterm pulmonary infiltrate with eosinophilia caused. The purpose of this study was to detail the clinical and pathologic presentation of pulmonary infiltrates with eosinophilia pie associated with nonsteroidal antiinflammatory drug use. Eosinophilic pulmonary diseases are a heterogeneous group of disorders characterized by the accumulation of eosinophils in alveolar spaces, the interstitium, or both.
Respiratory syndromes induced by this exposure included an acute sensitizing illness with dyspnea and wheezing in some workers and pulmonary infiltrates with eosinophilia in others. Here we report a case of lymphoma accompanied with pulmonary infiltrates and clinical feature of. Symptoms of acute schistosomiasis usually involve fever, malaise, and highgrade eosinophilia usually over 3,000 eosinophils 10 9 l. Pulmonary infiltrate an overview sciencedirect topics. The term migratory is used to describe recurrent pulmonary infiltrates that appear and resolve over a short period days to weeks, with new infiltrates developing elsewhere in the lungs. See also under ie acute eosinophilic pneumonia, xa dress, xvb and xixc. Looking for online definition of pulmonary infiltration with eosinophilia pie in the medical dictionary. Although aspergillus species are ubiquitous, ask about contact with soil or contaminated water sources abpa. Migratory pulmonary infiltrates in a patient with rheumatoid. This disease can be confused with tuberculosis, asthma, or coughs related to roundworms. The reaction commonly manifests as a febrile skin eruption with lymphadenopathy and malaise between two and eight weeks following drug exposure. Pulmonary infiltrates with eosinophilia pie are a group of heterogeneous disorders having the common findings of lung disease and eosinophilia in the peripheral blood, bronchoalveolar lavage. These initial four cases of aep were described to be of unknown cause.
Migratory pulmonary infiltrates are recognised in many lung diseases, the prototype of which is loefflers syndrome. These diseases are defined by eosinophilia in pulmonary infiltrates identified through bronchoalveolar lavagebal or in tissue identified. Eosinophilia can be present in blood, bal andor tissue xvb. Pdf on sep 1, 2014, sujeet raina and others published pulmonary infiltrates with eosinophiliaallergic granulomatosis of churg and strauss. The simplest form of the condition, in which patchy, migratory infiltrates cause minimal symptoms, is a selflimited reaction elicited by helminthic. Pulmonary infiltrates and eosinophilia in a 25yearold traveler jose mun. Pulmonary infiltratespulmonary infiltrates with eosinophilia dr abhishek go yal 151010. The syndrome of drug reaction with eosinophilia and systemic symptoms dress is a rare, yet potentially fatal hypersensitivity reaction, most commonly associated with anticonvulsants, sulfonamides, and allopurinol. They are typically, but not always, associated with peripheral eosinophilia and systemic symptoms. Pulmonary infiltrates and eosinophilia in a 25yearold. Shortterm pulmonary infiltrate with eosinophilia caused by. We report five unique cases of asthmainduced shortterm eosinophilic pneumonia encountered at our pulmonary and critical care centre in.
Ho et al 1 described two patients in whom administration of a tetracycline antibiotic was associated with diffuse skin rash and pulmonary infiltrates with eosinophilia report of a case. Eosinophilic lung diseases rsna publications online. Then 37 years elapsed before loefflers 3 classic report appeared, and 47 years before tropical eosinophilia was described by weingarten. Aug 23, 2019 asthma is often accompanied by peripheral eosinophilia and eosinophilic airway inflammation. Hypersensitivity pneumonitis and pulmonary infiltrates with. This article explores the relationship between asthma and shortterm pulmonary infiltrate with eosinophilia, which results from irregular asthma treatment. Piperacillinassociated pulmonary infiltrates with eosinophilia can respir j vol 17 no 2 marchapril 2010 e25 on day 6, when she returned to the emergency room, laboratory investigations revealed leukocytosis, with a white blood cell wbc count of 17. Simple pulmonary eosinophilia is inflammation of the lungs from an increase in eosinophils, a type of white blood cell. Persistent pulmonary infiltrate results when a substance denser than air e.
They may disappear with time or reappear in different areas of the lung. Pulmonary eosinophilic infiltrates include an heterogeneous group of disorders characterized by the presence of eosinophils in the lungs as detected by bronchoalveolar lavage or tissue biopsy. A group of patients who have pulmonary infiltrates with eosinophilia pie provide a similar diagnostic challenge this discussion. After ruling out heartworm disease, lungworms, fungal pneumonia and drug reactions, a diagnosis of pulmonary infiltrates with eosinophilia was made. Classic loeffiers syndrome probably represented a pulmonary response to underlying helminthic in fection. The diagnosis of eosinophilic lung disease can be made if any of the following. Casereports case 1 a 36yearold man who did not smoke was treated with. His private physician noted shifting pulmonary infiltrates on serial chest films, with persistent eosinophilia. Loeffler, in 1932, first described the syndrome now associated with his name, characterized by transient pulmonary infiltrate and high eosinophil counts in the peripheral blood.
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