Pulmonary eosinophilia with and without allergic bronchopulmonary aspergillosis.

Chapman, B.J.; Capewell, Simon; Gibson, Ronald L.; Greening, A P; Crompton, G.K.

doi:10.1136/thx.44.11.919

Cited by 27 publications

(13 citation statements)

References 25 publications

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“…Peripheral eosinophilia is common, a characteristic that makes it a prominent component of the differential diagnosis for pulmonary eosinophilia in the correct clinical context (18,21,154). Chest X-rays and CT scans of patients with ABPA may classically show patchy infiltrates, bronchiectasis, and evidence of mucous impaction (1,17,122).…”

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confidence: 99%

Eosinophilic Pneumonias

2012

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SUMMARY This review starts with discussions of several infectious causes of eosinophilic pneumonia, which are almost exclusively parasitic in nature. Pulmonary infections due specifically to Ascaris , hookworms, Strongyloides , Paragonimus , filariasis, and Toxocara are considered in detail. The discussion then moves to noninfectious causes of eosinophilic pulmonary infiltration, including allergic sensitization to Aspergillus , acute and chronic eosinophilic pneumonias, Churg-Strauss syndrome, hypereosinophilic syndromes, and pulmonary eosinophilia due to exposure to specific medications or toxins.

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confidence: 99%

Eosinophilic Pneumonias

2012

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“…The exact incidence is not known. In general, CEP presents radiographically as fluffy ground-glass area of opacification with ill-defined margins located in the lung periphery, a phenomenon that has been described as the photographic negative of pulmonary edema (3,4,6,9,17,21,22). Our patient, interestingly, presented with subpleural curvilinear shadow (SCLS) within both upper lung infiltates.…”

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confidence: 71%

“…Although peripheral blood eosinophilia is usually mild or moderate but occasionally is severe (7), increased serum IgE levels are seen in two-thirds of patients (16). Pulmonary infiltrates with eosinophils is the most important finding in this disease (3,4,5,6,9,17,21,22). Histologic examination typically shows accumulation of eosinophils and lymphocytes in the alveoli and interstitium, with interstitial fibrosis (3,10,15).…”

Section: Discussionmentioning

confidence: 99%

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Chronic Eosinophilic Pneumonia with Subpleural Curvilinear Shadow

Kagohashi

Ohara

Kurishima

et al. 2011

Acta Med. (Hradec Kralove, Czech Repub.)

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Chronic eosinophilic pneumonia (CEP) is characterized by a progressive symptomatic deterioration of more than 1 month, pulmonary infiltrates with eosinophils and the dramatic response to corticosteroid treatment (3,4,6,9,17,21,22). The exact incidence is not known. In general, CEP presents radiographically as fluffy ground-glass area of opacification with ill-defined margins located in the lung periphery, a phenomenon that has been described as the photographic negative of pulmonary edema (3,4,6,9,17,21,22). Our patient, interestingly, presented with subpleural curvilinear shadow (SCLS) within both upper lung infiltates. As this atypical presentation has scarcely been described previously, we herein report a case with this rare finding (6, 9, 18). Case ReportA 64-year-old female presented with a 4-month history of non-productive cough, fever, and night sweats. Her medical history was significant for diabetic mellitus. The patient did not smoke and she was not exposed to toxins, tropical diseases and legal or illegal drugs. A chest radiograph obtained by her general practitioner was suspicious of peripheral pulmonary infiltrates. The physical examination was unremarkable. No lymphadenopathy was present. Laboratory data were remarkable for white cell count of 9.5 x 10 9 /L with 23 % eosinophils and an immunoglobulin E (IgE) titer of 183 U/l. No biliary parasite was identified by sonography. Egg of parasite was not found in the stools and serological tests were negative for parasites. The chest radiograph on admission showed peripherally predominant pulmonary infiltrates, especially in the upper part of the both lungs (Fig. 1) Summary: We report a rare case of chronic eosinophilic pneumonia with subpleural curvilinear shadow. CT scan showed a patchy consolidation in the bilateral upper lungs. In addition, subpleural curvilinear shadow was found in the bilateral upper lungs. A bronchoalveolar lavage obtained from the right middle lobe showed 25 % eosinophils. Although very rare, we should therefore keep in mind that patients, who have patchy consolidation with areas of subpleural curvilinear shadow in the bilateral upper lungs, may have chronic eosinophilic pneumonia.

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“…Aspergillus airway colonization is particularly common in patients with cystic fibrosis (CF), where up to 80% of patients have A. fumigatus isolated from their sputum (4). A minority of these colonized patients (Ͻ10%) develop allergic bronchopulmonary aspergillosis (ABPA), characterized by an exuberant T helper 2 (Th2) response with elevated total and A. fumigatus-specific IgE levels, eosinophilia, and progressive reactive airway disease leading to bronchiectasis (5)(6)(7)(8). However, the majority of patients colonized with Aspergillus do not develop such a severe hypersensitivity reaction but still manifest a decline in lung function (3).…”

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confidence: 99%