Acute Eosinophilic Pneumonia with Eosinophilic Leukemoid Reaction: A Rare Hematologic Presentation

Abstract

Sir, A 26-year-old man presented to us with chief complaints of fever, cough, and dyspnea since 15 days. There was no history of hemoptysis, chest pain, orthopnea, palpitations, or edema feet. A more detailed history was negative for environmental or medication exposure. Past history was insignificant for any prolonged illness. There was no history of any addiction. On examination, pulse was 100/min, regular. Respiratory rate was 18/min, and the temperature was 38.6°C. JVP was not raised. Auscultation of the lungs revealed bilateral, diffuse rales. Cardiovascular system examination was normal. Investigations revealed, Hb of 11 g %, Total leucocyte count (TLC) was 52,000, DLC revealed polymorphs of 15 %, eosinophils 78 %, lymphocytes 6 %, monocyte 1 % (Fig. 1). Peripheral smear was devoid of any blasts. Absolute eosinophil count was 38,000/mm 3 (normal 52-250 mm 3). Platelet count was 250,000/mm 3. The bone marrow aspiration revealed eosinophilic proliferation without any blasts (Fig. 2). The blood biochemistry was normal. CXR revealed bilateral haziness. HRCT of thorax revealed bilateral ground glass opacities (GGOs) (Figs. 3, 4). Two dimensional (2D) echo was normal. ABG revealed partial pressure of oxygen, 68 mmHg; partial pressure of carbon dioxide, 29 mmHg; and pH, 7.50. SpO 2 was 84 % while patient was breathing ambient air. Cultures of