chronic eosinophilic pneumonia

Epidemiology

• > 50% have asthma of > 5 years duration
• female:male rato of 2:1
• most common in middle-aged women

Pathology

• high tissue eosinophilia
• bronchiolitis obliterans with organizing pneumonia (BOOP) ;

* histology images

Clinical manifestations

• insidious onset
• average duration of symptoms before diagnosis is made is 7 months
• cough (90%)
• fever (85%)
• dyspnea (60%), generally exertional dyspnea
• wheezing (35%)
• weight loss (56%) long-term smoker
• night sweats

Laboratory

• complete blood count (CBC) with differential
  • high eosinophilia > 40%
  • anemia
  • thrombocytosis
• serum IgE levels is increased in 65% of patients
• erythrocyte sedimentation rate (ESR) is increased in most patients
• iron studies: iron-deficiency anemia

Diagnostic procedures

• bronchoscopy makes diagnosis
  • bronchial alveolar lavage (BAL): high eosinophil count
  • biopsy generally not necessary

Radiology

• chest X-ray:
  • bilateral peripheral alveolar infiltrates
  • 'photographic negative' of pulmonary edema
• computed tomography (CT):
  • ground-glass peripheral infiltrates

Management

• long term (> 6 months) of corticosteroid therapy
• good response to steroids

More general terms

• eosinophilic pneumonia; Andrews syndrome; pulmonary eosinophilia
• chronic lung disease

Additional terms

• bronchiolitis obliterans; constrictive bronchiolitis; cryptogenic organizing pneumonia; bronchiolitis obliterans with organizing pneumonia (BOOP)
• eosinophilic bronchitis