Sulfa-induced acute eosinophilic pneumonia

Abstract

Acute eosinophilic pneumonia (AEP) is an infrequently seen interstitial lung disease secondary to medications. We report a series of 3 case of severe AEP which developed as a result of sulfa medication. 2 patients had received treatment with sulfamethoxazole for acne and 1 was treated with sulfasalazine for colitis. Patients were on sulfa medication for 1–3 weeks prior to presentation. All patients presented with fever, acute onset bilateral pulmonary infiltrates as well as marked peripheral eosinophilia. Mean eosinophil count was 2.21 × 10 9 /L. There was a lack of response to steroids. One patient required extracorporeal membrane oxygenation and prolonged mechanical ventilation via tracheostomy. 2 patients underwent successful lung transplantation (1 bilateral living-related lobar lung transplant and 1 orthotropic cardiopulmonary allotransplantation). In all cases lung biopsy and explants showed acute and organizing diffuse alveolar damage with increased interstitial and airspace eosinophils. To our knowledge, our series is the first to show the clinical features of sulfa induced AEP in an adolescent population.

Trimethoprim-sulfamethoxazole-induced lung injury: a case report

“…TMP-SMX-induced lung injury has been reported to manifest as hypersensitivity pneumonitis, acute fibrinous OP, and interstitial lung disease ( 2 - 4 ). Cases with similar clinical presentation and course to our patient, in particular the phenotype of TMP-SMX-induced ARDS associated with extensive pneumomediastinum and pneumothorax, have been reported ( 5 - 9 , 34 ). Majority of these cases have early air leaks even prior to intubation, as in our case, which appears to be a notable feature of patients with TMP-SMX-associated ARDS ( 9 ).…”

Sulfonamide-induced acute eosinophilic pneumonia requiring extracorporeal membrane oxygenation support: a case report

“…Sulfonamide-induced AEP is described as the cause of severe acute respiratory distress syndrome (ARDS). ( 4 - 6 ) Right ventricle failure (RVF) due to acute pulmonary hypertension may occur in up to 25% of severe ARDS patients. ( 7 ) Nitric oxide and veno-venous extracorporeal membrane oxygenation (VV-ECMO) support are therapeutic options, but little has been discussed about further options in refractory cases.…”

“…( 7 ) Nitric oxide and veno-venous extracorporeal membrane oxygenation (VV-ECMO) support are therapeutic options, but little has been discussed about further options in refractory cases. ( 4 - 6 )…”