Acute Eosinophilic Pneumonia as a Reversible Cause of Noninfectious Respiratory Failure

Abstract

Although chronic eosinophilic pneumonia is a well-known disorder, acute eosinophilic pneumonia has not been as well characterized. We describe the clinical features, results of bronchoalveolar lavage, and follow-up studies of four patients with acute eosinophilic pneumonia. The patients presented with an acute febrile illness, severe hypoxemia (partial pressure of arterial oxygen less than 60 mm Hg), diffuse pulmonary infiltrates, an increased number of eosinophils (mean +/- SEM, 42 +/- 4.8 percent) in bronchoalveolar-lavage fluid, and an absence of infection and previous atopic illness. The illness resolved rapidly after treatment with erythromycin and corticosteroids. The patients received doses of oral prednisone that were tapered over 10 days to 12 weeks, and none have relapsed since the steroids were discontinued. After a minimum follow-up period of five months, clinical evaluation, chest radiography, and pulmonary-function tests have shown no residual abnormalities attributable to the acute eosinophilic pneumonia. Follow-up bronchoalveolar lavage has demonstrated less than or equal to 1 percent eosinophils in all patients. We believe that we are describing an acute form of eosinophilic lung disease distinct from previously described syndromes. It can be diagnosed by bronchoalveolar lavage and seems to respond to treatment with corticosteroids.

KL-6 and Surfactant Proteins A and D in Serum and Bronchoalveolar Lavage Fluid in Patients with Acute Eosinophilic Pneumonia

“…The concept of acute eosinophilic pneumonia (AEP) was suggested by Allen and colleagues in 1989 (17). AEP has an acute onset, usually less than a week.…”

“…Patients present respiratory insufficiency, hypoxemia, fever, diffuse pulmonary infiltrates, increased numbers of eosinophils in BALF (of more than 25%), and no evidence of infection or previous atopic illness. It is also characterized by a rapid response to corticosteroids with resolution of symptoms and the improvement of radiographic abnormality without fibrosis (17,18). To our knowledge, no English-language reports have discussed KL-6, SP-A, or SP-D in both serum and BALF of AEP cases.…”

Acute Eosinophilic Pneumonia Following Cigarette Smoking: A Case Report Including Cigarette-Smoking Challenge Test.

“…Acute eosinophilic pneumonia (AEP) is characterized by eosinophilic infiltration in the lungs, respiratory distress, a rapid therapeutic response to corticosteroids and the absence of relapse (1). It has been proposed that AEPis associated with cigarette smoke (2,3).…”

Acute eosinophilic pneumonia associated with smoking: a case report

“…AEP is a serious and rare form of pulmonary eosinophilia which was first distinctly identified in 1989 by Allen et al [1]. It is characterized as a febrile illness associated with acute onset respiratory failure, bilateral diffuse pulmonary infiltrates on imaging and eosinophils >25% on BAL or lung biopsy.…”