Reevaluation of Eosinophilic Pneumonia and Its Diagnostic Criteria

Abstract

Eosinophilic pneumonia has been defined as pulmonary infiltration of the lung by eosinophils that may or may not be accompanied by an excess of these cells in the peripheral blood. However, the concept of this disease and its nomenclature have not yet been established. In the present study, the clinical course of 11 cases of eosinophilic pneumonia, which were clinico-pathohistologically diagnosed and found not to be associated with organic disorders producing peripheral blood eosinophilia, were investigated extensively and compared with various types of eosinophilic pneumonia, as previously reported. Of five cases of acute eosinophilic pneumonia with a history (less than 1 month) of symptoms before diagnosis, a short clinical course, and no recurrence, four cases showed peripheral blood eosinophilia, and four cases did not require treatment with steroids. Of six cases of chronic eosinophilic pneumonia with a history (greater than 2 months) of symptoms before diagnosis, a prolonged clinical course, and recurrence, all showed peripheral blood eosinophilia, four cases required treatment with steroids, and four cases were recurrent. In one case with simultaneous occurrence of asthma and another case with asthma that occurred 4 years after the appearance of eosinophilic pneumonia, abnormal shadows on chest roentgenograms had continued for several years. These results suggested that various types of previously reported eosinophilic pneumonia classified by sex, the presence or absence of peripheral blood eosinophilia, the degree of clinical symptoms or peripheral blood eosinophilia, and the degree of abnormalities on the chest roentgenograms should be extensively reevaluated.

The Long-term Clinical Course of Chronic Eosinophilic Pneumonia

“…talized with CEP at our institution in Saitama, Japan. With reference to previous reports (6,9,10) analyzing the characteristics of CEP, diagnosis of CEP was based on a greater than 2-month history of symptoms prior to diagnosis and fulfilment of at least one of the following criteria: (i) histological diagnosis by surgical or transbronchial lung biopsy, (ii) bronchoalveolar lavage fluid (BALF) eosinophilia >15%, and (iii) fulfilment of two of criteria (a)-(c): (a) peripheral blood eosinophilia (>0.5×10 9 /L), (b) BALF eosinophilia >10%, or (c) increase in eosinophils in lung tissue obtained via transbronchial lung biopsy (6,9). Serum IgE or IgG against several fungi was investigated via radioallergosorbent test, enzyme-linked immunoassay, and complement fixation method.…”

Chronic Eosinophilic Pneumonia with Subpleural Curvilinear Shadow

“…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.…”

“…

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.

…”

Emergency Cesarean Section as a Result of Acute Eosinophilic Pneumonia during Pregnancy

“…In their initial report, Allen et al (1989) presented the characteristics of acute eosinophilic pneumonia as follows: i) acute fever of < 7 days duration, ii) hypoxemia with a PaO 2 < 60 mmHg, iii) diffuse pulmonary shades on chest x-ray, iv) an increased eosinophil count in the bronchoalveolar lavage fluid (BALF) >25%, v) exclusion of clear infection, including those from parasites or fungi, vi) absence of a history of bronchial asthma and other allergic disease, vii) prompt response to treatment with steroids, and viii) no recurrence after discontinuation of treatment. While these characteristics are currently often used as the diagnostic criteria, later reports have expressed the opinion that even if some of these criteria are not met, those cases with many of these characteristics may be considered to be acute eosinophilic pneumonia (Umeki 1992;Hayakawa et al 1994).…”