Eosinophilic lung disease associated with Candida albicans allergy

Abstract

There are few references in the literature about the role of Candida albicans (CA) in eosinophilic lung disease. Asthma related to immunoglobulin (Ig)E-mediated allergy to CA [1] as well as allergic bronchopulmonary candidiasis has been described [2], but the implication of CA in chronic eosinophilic pneumonia has not been previously reported. In this paper we report on a patient in whom chronic eosinophilic pneumonia developed and levels of specific anti-CA IgE in the serum paralleled the clinical course of the disease. Case reportA 43 yr old female was admitted to the hospital reporting symptoms of an intermittent fever of 38°C, nocturnal sweat, chills, dyspnoea, dry cough and malaise, with a weight loss of 4-5 kg during the last 45 days. No improvement was observed despite several courses of amoxicillin and cephalosporin being given. These symptoms were reported by the family because she had had severe mental deficiency since 11 months of age, as a result of severe traumatic head injury. The physical examination revealed a respiratory frequency of 32 breaths·min -1 and crackles in both pulmonary bases. The blood count detected 2,400 eosinophils·mm -3 . The chest radiograph showed a patchy, nonsegmental infiltrate of peripheral distribution in the upper right lobe. This radiological pattern changed its localization at 48 h, inside the same lobe ( fig. 1). There was no previous history of asthma, ingestion of drugs or inhalation of fumes. Although bronchoscopy was indicated, transbronchial biopsy was not possible owing to a lack of collaboration. Bronchoalveolar lavage (BAL) showed a predominant fraction of 40% eosinophils in cytological analysis, with 57% macrophages and 3% lymphocytes. CA was the only fungus isolated from the BAL culture.The serum rheumatoid factor, anti-nuclear antibody, canti-neutrophil cytoplasmic antibody (ANCA) and p-ANCA were all negative. Negative skin-prick test responses were obtained to grass, weed and tree pollens, house dust mite and dog and cat dander. Four examinations of stools for ova of parasites at different times were negative. Total serum IgE and antifungus specific IgE were determined by a fluoroenzyme immunoassay (CAP System; Pharmacia Diagnostics, Uppsala, Sweden) and the results expressed in kU·L -1 . Specific anti-fungus IgG was assessed by an enzyme-linked immunosorbent assay (ELISA) method as described previously [3] and the results were expressed in optical densities (OD). A value at least twice over the negative control (0.6 OD) was considered positive. Serum immunological assays were carried out for seven fungi: Mucor spp., Penicillium spp., Alternaria alternata, Aspergillus fumigatus, Cladosporium herbarum, Trichophyton and CA, and also for Echinococcus granulosus and Toxocara canis. A positive result was only detected for anti-CA IgE: 32.7 kU·L -1 (normal <0.35 kU·L -1 ). The ELISA deter-mination of anti-CA IgG showed a titre of 2.3 OD. Total serum IgE was 1,430 kU·L -1 . Leukocyte histamine release test using peripheral blood was performed as described previou...

New Perspectives in the Diagnosis and Management of Allergic Fungal Airway Disease

“…Eosinophilic pneumonia with extensive lung shadowing associated with a marked BAL and blood eosinophilia, which is highly glucocorticoid sensitive, is a well-recognised complication of AFAD and has also been described in the context of IgE sensitisation to C. albicans . 115 , 116 A large dose of inhaled A. fumigatus spores, for example in the context of gardening or indoor contamination, can sometimes be identified as a trigger. Similarly, lobar collapse due to large-airway obstruction with inspissated mucus is a classical if unusual presentation.…”

Clinical Case Notes

“…No common causative factor or linkage has been described as yet in the literature. Selective sensitization to C. albicans , however, has been demonstrated in chronic eosinophilia pneumonia 8 . Levels of specific immunoglobulins against C. albicans were shown to diminish with corticosteroid treatment and increase with a recurrence of symptoms upon lowering of the corticosteroid dosage 8 .…”

“…Selective sensitization to C. albicans , however, has been demonstrated in chronic eosinophilia pneumonia 8 . Levels of specific immunoglobulins against C. albicans were shown to diminish with corticosteroid treatment and increase with a recurrence of symptoms upon lowering of the corticosteroid dosage 8 . More recently, cytokine profiles have shown that the C. albicans allergen may be involved in airway eosinophilic inflammation through the induction of the interleukin (IL)‐5 cytokine production by T helper cells 9 .…”

Acute eosinophilic pneumonia caused by Candida albicans

“…1,2 Since then, many factors such as drugs, cigarette smoke, and fungi have been implicated as causes of AEP. 3,4 There are few references in the literature regarding the role of Candida albicans in eosinophilic lung disease, 5 although it is well known that C. albicans is one of the aeroantigens that causes bronchial asthma and allergic bronchopulmonary candidiasis. 6 We present here the first case of acute onset eosinophilic pneumonia induced by C. albicans.…”