Eosinofilia pulmonar

Abstract

Pulmonary eosinophilia comprises a heterogeneous group of diseases defined by eosinophilia in pulmonary infiltrates (bronchoalveolar lavage fluid) or in tissue (lung biopsy specimens). Although the inflammatory infiltrate is composed of macrophages, lymphocytes, neutrophils and eosinophils, eosinophilia is an important marker for the diagnosis and treatment. Clinical and radiological presentations can include simple pulmonary eosinophilia, chronic eosinophilic pneumonia, acute eosinophilic pneumonia, allergic bronchopulmonary aspergillosis and pulmonary eosinophilia associated with a systemic disease, such as in Churg-Strauss syndrome and hypereosinophilic syndrome. Asthma is frequently concomitant and can be a prerequisite, as in allergic bronchopulmonary aspergillosis and Churg-Strauss syndrome. In diseases with systemic involvement, the skin, the heart and the nervous system are the most affected organs. The radiological presentation can be typical, or at least suggestive, of one of three types of pulmonary eosinophilia: chronic eosinophilic pneumonia, acute eosinophilic pneumonia and allergic bronchopulmonary aspergillosis. The etiology of pulmonary eosinophilia can be either primary (idiopathic) or secondary, due to known causes, such as drugs, parasites, fungal infection, mycobacterial infection, irradiation and toxins. Pulmonary eosinophilia can be also associated with diffuse lung diseases, connective tissue diseases and neoplasia.Keywords: Pulmonary eosinophilia; Hypereosinophilic syndrome; Aspergillosis, allergic bronchopulmonary; Churg-Strauss syndrome. ResumoAs formas de eosinofilia pulmonar constituem um grupo heterogêneo definido pela presença de um ou dois critérios: infiltrado pulmonar com eosinofilia sanguínea e/ou eosinofilia tissular caracterizada por eosinófilos demonstrados na biópsia pulmonar ou no lavado broncoalveolar. Embora o infiltrado inflamatório seja composto de macrófagos, linfócitos, neutrófilos e eosinófilos, a presença de eosinofilia é um marcador importante para o diagnóstico e tratamento. A apresentação clínica e radiológica pode revelar eosinofilia pulmonar simples, pneumonia eosinofílica crônica, pneumonia eosinofílica aguda, aspergilose broncopulmonar alérgica e eosinofilia pulmonar associada à doença sistêmica, como na síndrome de Churg-Strauss e na síndrome hipereosinofílica. A asma está frequentemente associada, podendo ser um pré-requisito, como na aspergilose broncopulmonar alérgica e na síndrome de Churg-Strauss. Nas doenças com acometimento sistêmico, a pele, o coração e o sistema nervoso são os órgãos mais comprometidos. A apresentação radiológica pode ser considerada como típica, ou pelo menos sugestiva, para três formas de eosinofilia pulmonar: pneumonia eosinofílica crônica, aspergilose broncopulmonar alérgica e pneumonia eosinofílica aguda. A etiologia da eosinofilia pulmonar pode ser de causa primária (idiopática) ou secundária, compreendendo causas conhecidas, como drogas, parasitas, infecções por fungos e micobactérias, irradiação e toxinas. A eosinof...

The Immune Cell Composition in Barrett's Metaplastic Tissue Resembles That in Normal Duodenal Tissue

“…The morphology of eosinophils in BE and duodenum [16], [17] exhibited a similar non-polarized, not-activated phenotype, which is in contrast to eosinophils found in allergic disorders that are polarized with the presence of free granules [18], [19]. This finding is the first indication that immune cells in BE are similar to those normally found in intestinal tissue and that their presence is likely not to be a consequence of inflammation.…”

Chronic eosinophilic pneumonia due to radiographic contrast administration: an orphan disease?

“…A modern classification categorizes the eosinophilic lung diseases into those of unknown cause (simple pulmonary eosinophilia [SPE], acute eosinophilic pneumonia [AEP], chronic eosinophilic pneumonia [CEP], idiopathic hypereosinophilic syndrome [HIS]) and those of known cause (allergic bronchopulmonary aspergillosis [ABPA], bronchocentric granulomatosis [BG], parasitic infection, drug-induced reaction, fungal and mycobacterial infection, pulmonary diseases caused by radiation or toxins). Another group contains eosinophilic vasculitis (allergic angiitis, granulomatosis [Churg–Strauss syndrome]) 9,10. PIE can also be associated with connective tissue diseases and neoplasms.…”

“…Iodinated contrast material and blood transfusions have also been reported as possible causes 3–7. Patients with drug-induced PIE can present with a variety of pathologic conditions ranging from a mild SPE-like syndrome to a fulminant AEP-like syndrome, which is why desquamative interstitial pulmonary interstitial eosinophilia (DI-PIE) is indistinguishable from idiopathic eosinophilic pneumonia (simple, acute, or chronic) by clinical, radiographic, and histopathologic criteria 8–10…”

“…Exposure to certain parasites (in endemic regions) or toxic products (a history of smoking), a history of asthma and atopy (which may raise suspicion for Churg–Strauss syndrome, ABPA, or BG), connective tissue diseases, and neoplasia must be carefully excluded. The diagnosis is also supported by a definite temporal association between exposure to the agent and the development of respiratory signs and symptoms 9. There should be no evidence of ILD prior to treatment with the suspected drug; thus, review of earlier chest films is required.…”

“…The condition usually resolves with removal from the agent and recurs with rechallenge. Difficulties arise when signs and symptoms develop after the drug is discontinued or when drug withdrawal does not translate into improvement, as in patients with pulmonary fibrosis 10,11…”