Allergy Asthma Immunol Res.  2013 Jul;5(4):242-244. 10.4168/aair.2013.5.4.242.

Acute Eosinophilic Pneumonia Leading to Acute Respiratory Failure in a Current Systemic Corticosteroid User

• Shin HY
• Choe JW
• Kwon M
• Jang JY
• Jung JW
• Choi JC
• Shin JW
• Park IW
• Choi BW
• Kim JY

• KMID: 2260319
• DOI: http://doi.org/10.4168/aair.2013.5.4.242

Abstract

A 69-year-old female patient visited the emergency room with fever (38.3degrees C) and dyspnea. She had been taking prednisolone (5 mg once per day) and methotrexate (2.5 mg once per week) for rheumatoid arthritis for 2 years. Chest computed tomography (CT) showed bilateral, multifocal ground glass opacity with interlobular septal thickening. Peripheral blood leukocyte count was 6,520/mm3 (neutrophils, 77.4%; eosinophils, 12.1%). During the night, mechanical ventilation was initiated due to the development of severe hypoxemia. Bronchoalveolar lavage fluid showed a high proportion of eosinophils (49%). Her symptoms improved dramatically after commencement of intravenous methylprednisolone therapy. This is the first report of idiopathic acute eosinophilic pneumonia developing in a current user of systemic corticosteroids.

Keyword

Acute eosinophilic pneumonia; respiratory failure; corticosteroid

MeSH Terms

Adrenal Cortex Hormones
Anoxia
Arthritis, Rheumatoid
Bronchoalveolar Lavage Fluid
Dyspnea
Emergencies
Eosinophils
Female
Fever
Glass
Humans
Leukocyte Count
Methotrexate
Methylprednisolone
Prednisolone
Pulmonary Eosinophilia
Respiration, Artificial
Respiratory Insufficiency
Thorax
Adrenal Cortex Hormones
Methotrexate
Methylprednisolone
Prednisolone

Figure

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  Fig. 1 Chest PA and chest CT taken on the day of arrival (hospital day 0). (A) Chest PA showed bilateral diffuse lung infiltration. (B) Chest CT demonstrated peribronchial consolidations and ground-glass opacities in the upper and lower zones of both lungs. Interlobular septal thickenings were observed at both the upper lobe and basal lungs.

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  Fig. 2 Chest PA taken on hospital day 1 showed acute aggravation of lung infiltration.

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  Fig. 3 Chest PA taken on hospital day 4 indicated marked improvement of lung infiltration.

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