Acute Eosinophilic Pneumonia Following Cigarette Smoking.

Abstract

Twocases of acute eosinophilic pneumoniafollowing cigarette smoking are analyzed for characteristic features. The first patient noted dyspnea 14 days after initiation of smoking. The second patient noted dyspnea 12 days after beginning to smoke. Both cases had characteristic features including occurrence at an age younger than 30 years; less than 1 month duration of cigarette smoking before onset of disease ; and no identifiable cause of acute eosinophilic pneumoniaapart from smoking. Webelieve that acute eosinophilic pneumonia following cigarette smoking, which has characteristic features as described above, should be considered as a distinct subtype of AEP. (Internal Medicine 39: 830-833, 2000)

Acute Eosinophilic Pneumonia Following Cigarette Smoking

“…Regarding peripheral eosinophilia, it is absent during the acute stage of AEP, but usually appears during the recovery stage. CS-AEP patients may also develop eosinophilia during the recovery stage, which has been reported in this issue (13). Although some investigators have reported a relationship between cigarette smoking and eosinophilia (15)(16)(17)(18)(19), it is not well knownthat cigarette smokecan induce acute eosinophilia.…”

“…Although we first recognized and reported on CS-AEP, a number of cases must have previously gone unrecognized as such and thus unreported. Weagree with one of the conclusions of Shiota et al (13) that the high incidence in the literature ofAEP occurring within a month after initial cigarette smoking is not merely coincidental. …”

“…Wethink that tolerance may be induced by resumption of cigarette smoking in CS-AEPwith only acute eosinophilia or with no abnormal laboratory data and/or no symptoms. Shiota et al (13) in this issue examined previous literature on AEP, and found a high incidence in the initial cigarette smoking in young AEP patients. In 1998, we also reviewed the English and Japanese literature on AEPto search for histories of smoking in AEP cases (9), using the following criteria [modified AEP criteria of Allen et al (3)] for the diagnosis ofAEP; 1) onset of any symptomoccurring 7 days before visit to physician, 2) BALdifferential with^25% eosinophils or pathologically proven eosinophilic pneumonia, 3) mild-to-severe symptoms of cough, dyspnea, and fever, 4) bilateral infiltrate shadows on chest X-ray, 5) a recovery in a short clinical course of less than a week, and 6) no apparent causes ofAEPdetectable.…”

“…Althoughcigarette smoking may induce tolerance, physicians should be aware of the danger of developing respiratory failure following a provocation test. In fact, Shiota et al (13) and some other investigators have reported that AEPmight have recurred following cigarette smoking and that a provocation test might have induced respiratory failure in once improved CS-AEP patients. Regarding peripheral eosinophilia, it is absent during the acute stage of AEP, but usually appears during the recovery stage.…”

Clinical laboratory testing for smoking toxicity: implications for early identification of respiratory diseases

“…24 The implication is that eosinophilic pneumonia is associated with cigarette smoking. [31][32][33][34] Indeed, it is very plausible that BAL may be useful for screening early or subclinical respiratory diseases among cigarette smokers. 35 Respiratory diseases are also associated with rheological properties of blood, which in turn constitute subclinical vasculopathy with known laboratory biomarkers and cigarette smoke.…”