Eosinophilic pneumonias PULMONARY INFILTRATES WITH EOSINOPHILIA

PULMONARY INFILTRATES WITH EOSINOPHILIA

  • Allergic bronchopulmonary aspergillosis
  • called eosinophilic pneumonias
  • Characterized by eosinophilic infiltrates in lungs and Increased eosinophilic count in peripheral blood.
  • Characterized by eosinophilic lung infiltrates, with or without peripheral blood eosinophilia
  • Chronic or prolonged pulmonary eosinophilia
  • Churg-Strauss syndrome (polyarteritis nodosa) or allergic angiitis: A rare necrotizing small-vessel vasculitis associated with eosinophil-rich granulomatous inflammation of tissues and vessels
  • Classified as acute (AEP) or chronic (CEP), and can be either idiopathic or secondary to other causes
  • Drug-induced pulmonary eosinophilia
  • Hypereosinophilic syndrome
  • Loeffler’s syndrome is a transient, reversible syn­drome of migratory pulmonary infiltrates and eosino­philia of unknown cause .
  • There are several immunologically mediated lungdis­eases with eosinophilia.
  • Tropical pulmonary eosinophilia

eosinophilic pneumonias

ACUTE Eosinophilic pneumonias PULMONARY

CHRONIC eosinophilic pneumonias

CHRONIC Eosinophilic pneumonias PULMONARY


Etiology PULMONARY INFILTRATES WITH EOSINO­PHILIA

  • Aspergillus fumigatus(asthmatic pulmonary eosinophilia)
  • Environmental factors
  • Has been reported after cigarette smoking and exposure to smoke
  • Hypersensitivity to unknown agents
  • Tropical: Parasites, filariae, nematodes
  • Allergic bronchopulmonary mycoses ¥ Parasitic infestations
  • Drug reactions
  • Eosinophilia myalgia syndrome
  • Hypereosinophilic syndrome.
  • Idiopathic eosinophilic conditions are:
  • Loeffler’s syndrome

 

Initial Lab Tests

Blood:

  • Complete blood count (CBC) shows leukocytosis and eosinophilia
  • Elevated erythrocyte sedimentation rate (ESR)
  • Elevated IgE level

Differential Diagnosis PULMONARY INFILTRATES WITH EOSINO­PHILIA

  • Desquamative interstitial pneumonitis
  • Eosinophilic granuloma of the lung
  • Hodgkin lymphoma
  • Hypereosinophilic syndrome
  • Interstitial lung disease
  • Other lymphoproliferative disorders
  • Sarcoidosis
  • Tuberculosis
  • Wegener granulomatosis

Follow-up Recommendations

Prognosis

  • Excellent in the milder forms
  • Corticosteroid therapy is dramatically effective in more severe cases.

Patient Monitoring

  • Physical examinations and CXRs until resolved

Patient Education

  • Provide information about activity, diet, and symptoms of recurrence, and advise patient to avoid exposure of offending agent, if possible.

Diet

  • High-calorie, high-protein, soft diet