J Korean Med Sci.  2008 Feb;23(1):134-137. 10.3346/jkms.2008.23.1.134.

Cigarette Smoking-Induced Acute Eosinophilic Pneumonia: A Case Report Including a Provocation Test

• Bok GH
• Kim YK
• Lee YM
• Kim KU
• Uh ST
• Hwang JH
• Kim DW

• KMID: 1786860
• DOI: http://doi.org/10.3346/jkms.2008.23.1.134

Abstract

The mechanism and cause of acute eosinophilic pneumonia are largely unknown. Many factors including the smoking of cigarettes have been suggested, but none have been proven to directly cause acute eosinophilic pneumonia. The authors report a case of acute eosinophilic pneumonia in a young Asian male who recently started smoking. The diagnosis was made based on his clinical course and results of chest radiography, lung spirometry, bronchoalveolar lavage, and transbronchial lung biopsies. After administration of methylprednisolone, his clinical course rapidly improved. A provocation test was designed to establish a connection between cigarette smoking and the development of acute eosinophilic pneumonia. After the provocation test, the patient showed identical symptoms, increase in sputum eosinophils, and worsening of pulmonary function. The results of the provocation test suggest that smoking may directly cause acute eosinophilic pneumonia, and support previous reports of cigarette smoking-induced acute eosinophilic pneumonia.

Keyword

Acute Eosinophilic Pneumonia; Smoking; Provocation Test

MeSH Terms

Acute Disease
Adolescent
*Bronchial Provocation Tests
Humans
Male
Pulmonary Eosinophilia/*etiology/physiopathology
Smoking/*adverse effects

Figure

• 

  Fig. 1 The time axis of sputum eosinophil percentage, absolute eosionphil count per microliter, chest radiograph, and high resolution computed tomography findings. Administration of 125 mg/day of methylprednisolone is shown by short arrows. The cigarette smoking challenge test is shown by the long arrow. Multifocal patchy infiltrates and interlobular septae thickening can be seen on chest radiography and high-resolution computed tomography. After administration of methlyprednisolone, the infiltrates and elevated sputum eosinophil percentage rapidly resolved. After the cigarette smoking challenge test, a sharp increase of in sputum eosinophils was observed, but there were no recurrent findings of lung infiltrates on chest radiography.

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  Fig. 2 The cigarette smoking challenge test and changes in body temperature, forced vital capacity (FVC), forced expiratory volume of 1 sec (FEV1), and diffusion of carbon monoxide (DLco) with respect to the elapsed time after smoking. Approximately 3 hr after smoking, a moderate decrease in DLco and mild decrease in FVC and FEV1 were observed. Body temperature reached its peak 6 hr after the first cigarette smoking.

• 

  Fig. 3 Transbronchial lung biopsy showing marked infiltration of eosinophils and interstitial thickening. Eosinophils are shown by arrows.

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