Abstract
Chronic eosinophilic pneumonia is a rare interstitial lung disorder, which causes diagnostic difficulties. Often the disease is diagnosed correctly after several weeks or months following initial presentation. The aim of the study was to prospectively evaluate peculiarities of manifestation of idiopathic chronic eosinophilic pneumonia (ICEP), which may allow to improving early diagnosis. Twenty patients with ICEP were involved in this investigation. The cases of acute eosinophilic pneumonia and cases of chronic eosinophilic pneumonia of known origin were excluded. To define archetypal signs of the idiopathic chronic eosinophilic pneumonia, 3 comparable groups were selected. They were the group of 50 patients with community-acquired pneumonia (COP); the group of 21 asthmatic patients with COP, and the cluster of 10 patients with morphologically confirmed cryptogenic organizing pneumonia (OP). Clinical and radiological manifestation of ICEP was similar to COP and cryptogenic OP manifestation. We have found that chest pain; fine rales and pleurisy were unrepresentative for ICEP. However, blood eosinophilia was typical sign of ICEP and wheezing was a frequent observation. Usually ICEP patients had relative mild clinical symptoms and moderate increased C reactive protein (CRP) level even in cases of multiple pulmonary infiltrates. In conclusion, in cases of not typical pneumonia course, i.e. non-resolving or recurrent pulmonary infiltrates; relative mild clinical symptoms and moderate increased CRP level with multiple pulmonary infiltrates; blood eosinophilia and/or signs of airway obstruction eosinophilic pneumonia should be suspected and bronchoalveolar lavage and/or bronchoscopic lung biopsy performed.
[1] Crofton J.W., Livingstone J.L., Oswald N.C., Roberts A.T.M., Pulmonary eosinophilia, Thorax, 1952, 7, 1–35 http://dx.doi.org/10.1136/thx.7.1.110.1136/thx.7.1.1Search in Google Scholar
[2] Ogawa H., Fujimura M., Matsuda T., Nakamura H., Kumabashiri I., Kitagawa S. Transient wheeze. Eosinophilic bronchobronchiolitis in acute eosinophilic pneumonia, Chest, 1993, 104, 493–6 http://dx.doi.org/10.1378/chest.104.2.49310.1378/chest.104.2.493Search in Google Scholar
[3] Boomars K.A., van Velzen-Blad H., Mulder P.G., Koenderman L., Lammers J.W., van den Bosch J.M.M., Eosinophil cationic protein and immunoglobulin levels in bronchoalveolar lavage fluid obtained from patients with chronic eosinophilic pneumonia, Eur. Respir. J, 1996, 9, 2488–93 http://dx.doi.org/10.1183/09031936.96.0912248810.1183/09031936.96.09122488Search in Google Scholar
[4] Trawick D., Kotch A., Matthay R., Homer R.J., Eosinophilic pneumonia as a presentation of occult chronic granulomatous disease, Eur. Respir. J., 1997, 10, 2166–70 http://dx.doi.org/10.1183/09031936.97.1009216610.1183/09031936.97.10092166Search in Google Scholar
[5] Shorr A.F., Scoville S.L., Cersovsky S.B., Shanks G.D., Ockenhouse C.F., Smoak B.L., et al., Acute eosinophilic pneumonia among US military personnel deployed in or near Iraq, J. A. M. A., 2004, 292, 2997–3005 http://dx.doi.org/10.1001/jama.292.24.299710.1001/jama.292.24.2997Search in Google Scholar
[6] Souza C.A., Müller N.L., Johkoh T., Akira M. Drug-induced eosinophilic pneumonia: high-resolution CT findings in 14 patients, A. J. R., 2006, 186, 368–73 10.2214/AJR.04.1847Search in Google Scholar
[7] Espeleta V.J., Moore W.H., Kane P.B., Baram D., Eosinophilic pneumonia due to duloxetine, Chest, 2007, 131, 901–3 http://dx.doi.org/10.1378/chest.06-165910.1378/chest.06-1659Search in Google Scholar
[8] Carrington C.B., Addington W.W., Goff A.M., Madoff I.M., Marks A., Schwaber J.R., et al., Chronic eosinophilic pneumonia, N. Engl. J. Med., 1969, 280, 787–98 10.1056/NEJM196904102801501Search in Google Scholar
[9] Allen J.N., Pacht E.R., Gadek J.E., Davis W.B., Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure, N. Engl. J. Med., 1989, 321, 569–74 10.1056/NEJM198908313210903Search in Google Scholar
[10] Fujimura M., Yasui M., Shinagawa S., Nomura M., Matsuda T., Bronchoalveolar lavage cell findings in three types of eosinophilic pneumonia: acute, chronic and drug-induced eosinophilic pneumonia, Respir. Med., 1998, 92, 743–9 http://dx.doi.org/10.1016/S0954-6111(98)90006-310.1016/S0954-6111(98)90006-3Search in Google Scholar
[11] Allen J.N., Eosinophilic Lung Diseases, PCCU, 2004, 18, 14 lesson. www.chest.net. Search in Google Scholar
[12] Umeki S., Soejima R., Acute and chronic eosinophilic pneumonia: clinical evaluation and the criteria, Inter. Med., 1992, 31, 847–56. http://dx.doi.org/10.2169/internalmedicine.31.84710.2169/internalmedicine.31.847Search in Google Scholar PubMed
[13] Hayakawa H., Sato A., Toyoshima M., Imokawa S., Taniguchi M., A clinical study of idiopathic eosinophilic pneumonia, Chest, 1994, 105, 1462–6 http://dx.doi.org/10.1378/chest.105.5.146210.1378/chest.105.5.1462Search in Google Scholar PubMed
[14] Danila E., Rare case of eosinophilic pneumonia, Vaiku pulmonologija ir alergologija, 1999, 2, 474–8 (in Lithuanian) Search in Google Scholar
[15] Inoue K., Inoue Y., Arai T., Nawa Y., Kashiwa Y., Yamamoto S., et al., Chronic eosinophilic pneumonia due to visceral larva migrants, Inter. Med., 2002, 41, 478–82 http://dx.doi.org/10.2169/internalmedicine.41.47810.2169/internalmedicine.41.478Search in Google Scholar PubMed
[16] Xie L.X., Mo G.X., Chen L.A., Liu Y.N., Chronic eosinophilic pneumonia with mucous plugs: case report, Chin. Med. J. 2006, 119, 262–4 10.1097/00029330-200602010-00019Search in Google Scholar
[17] Mitra S., Kundu S., Asthma, tuberculosis or eosinophilic pneumonia?, Lung India, 2007, 24, 94–6 10.4103/0970-2113.44224Search in Google Scholar
[18] Gallipoli P., Leach M., A case of chronic eosinophilic pneumonia, J. R. Coll. Physicians Edinb., 2007, 37, 207–9 Search in Google Scholar
[19] Marchand E., Etienne-Mastroianni B., Chanez P., Lauque D., Leclerc P., Cordier J-F., Idiopathic chronic eosinophilic pneumonia and asthma: how do they influence each other?, Eur. Respir. J., 2003, 22, 8–13 http://dx.doi.org/10.1183/09031936.03.0008560310.1183/09031936.03.00085603Search in Google Scholar PubMed
[20] Danila E., Zurauskas E., Loskutoviene G., Zablockis R., Nargela R., Birzietyte V., et al., Significance of bronchoscopic lung biopsy in clinical practice, Adv. Med. Sci., 2008, 53, 11–6 http://dx.doi.org/10.2478/v10039-008-0011-210.2478/v10039-008-0011-2Search in Google Scholar PubMed
[21] Danila E., Jurgauskiene L., Malickaite R., BAL fluid cells and pulmonary function in different radiographic stages of newly diagnosed sarcoidosis, Adv. Med. Sci., 2008, 53, 228–33 http://dx.doi.org/10.2478/v10039-008-0014-z10.2478/v10039-008-0014-zSearch in Google Scholar PubMed
[22] Danila E., Zurauskas E., Diagnostic value of epithelioid cell granulomas in bronchoscopic biopsies, Inter. Med., 2008, 47, 2121–6. http://dx.doi.org/10.2169/internalmedicine.47.145210.2169/internalmedicine.47.1452Search in Google Scholar PubMed
[23] Danila E., Jurgauskiene L., Norkuniene J., Malickaite R., BAL fluid cells in newly diagnosed pulmonary sarcoidosis with different clinical activity, Ups. J. Med. Sci., 2009, 114, 26–31. http://dx.doi.org/10.1080/0300973080257972910.1080/03009730802579729Search in Google Scholar PubMed PubMed Central
[24] Danila E., Norkuniene J., Jurgauskiene L., Malickaite R., Diagnostic role of BAL fluid CD4/CD8 ratio in different radiographic and clinical forms of pulmonary sarcoidosis, Clin. Respir. J., 2009, (in press), DOI: 10.1111/j.1752-699X.2008.00125.x. 10.1111/j.1752-699X.2008.00125.xSearch in Google Scholar PubMed
[25] Marchand E., Cordier J.F., Idiopathic chronic eosinophilic pneumonia, Orphanet J. Rare Dis., 2006, 1, 11, http://www.OJRD.com/content/1/1/11 http://dx.doi.org/10.1186/1750-1172-1-1110.1186/1750-1172-1-11Search in Google Scholar PubMed PubMed Central
[26] Bartlett J.G., Mundy L.M., Community-acquired pneumonia, N. Engl. J. Med., 1995, 333, 1618–24 http://dx.doi.org/10.1056/NEJM19951214333240810.1056/NEJM199512143332408Search in Google Scholar PubMed
[27] Kradin R.L, Mark E.J., Case 32-1998. N. Engl. J. Med., 1998, 339, 1228–36 http://dx.doi.org/10.1056/NEJM19981022339170810.1056/NEJM199810223391708Search in Google Scholar PubMed
[28] Arakawa H., Kurihara Y., Niimi H., Nakajima Y., Johkoh T., Nakamura H., Bronchiolitis obliterans with organizing pneumonia versus chronic eosinophilic pneumonia: high-resolution CT. Findings in 81 patients, A. J. R., 2001, 176, 1053–8 10.2214/ajr.176.4.1761053Search in Google Scholar PubMed
[29] Cordier J-F., Cryptogenic organizing pneumonia, Eur. Respir. J., 2006, 28, 422–46 http://dx.doi.org/10.1183/09031936.06.0001350510.1183/09031936.06.00013505Search in Google Scholar PubMed
[30] Durieu J., Wallaert B., Tonnel A.B., Long-term follow-up of pulmonary function in chronic eosinophilic pneumonia, Eur. Respir. J., 1997, 10, 286–91 http://dx.doi.org/10.1183/09031936.97.1002028610.1183/09031936.97.10020286Search in Google Scholar PubMed
[31] Wubbel C., Fulmer D., Sherman J., Chronic eosinophilic pneumonia: A case report and national survey, Chest, 2003, 123, 1763–6 http://dx.doi.org/10.1378/chest.123.5.176310.1378/chest.123.5.1763Search in Google Scholar PubMed
[32] Philit F., Etienne-Mastroïanni B., Parrot A., Guerin C., Robert D., Philit F., Idiopathic acute eosinophilic pneumonia: a study of 22 patients, Am. J. Respir. Crit. Care Med., 2002, 166, 1235–9 http://dx.doi.org/10.1164/rccm.211205610.1164/rccm.2112056Search in Google Scholar PubMed
[33] Hoare Z., Lim W.S., Pneumonia: update on diagnosis and management, B. M. J., 2006, 332, 1077–9 http://dx.doi.org/10.1136/bmj.332.7549.107710.1136/bmj.332.7549.1077Search in Google Scholar PubMed PubMed Central
[34] Sveinsson O.A., Isaksson H.J., Gudmundsson G., Chronic eosinophilic pneumonia in Iceland: clinical features, epidemiology and review, Laeknabladid, 2007, 93, 109–14, (in Icelandic) Search in Google Scholar
[35] Almirall J., Bolíbar I., Toran P., Pera G., Boquet X., Balanzo X., et al., Contribution of C-reactive protein to the diagnosis and assessment of severity of community-acquired pneumonia, Chest, 2004, 125, 1335–42 http://dx.doi.org/10.1378/chest.125.4.133510.1378/chest.125.4.1335Search in Google Scholar PubMed
[36] Meer V., Neven A.K., Broek P.J., Assendelft W.J.J., Diagnostic value of C reactive protein in infections of the lower respiratory tract: systematic review, B. M. J., 2005, 331, 1–6 http://dx.doi.org/10.1136/bmj.331.7507.110.1136/bmj.331.7507.1Search in Google Scholar PubMed PubMed Central
[37] Jeong Y.J., Kim K-I., Seo I.J., Lee C.H., Lee K.N., Kim K.N., et al., Eosinophilic lung diseases: a clinical, radiologic, and pathologic overview, RadioGraphics, 2007, 27, 617–37 http://dx.doi.org/10.1148/rg.27306505110.1148/rg.273065051Search in Google Scholar PubMed
[38] Johkoh T., Muller N.L., Akira M., Ichikado K., Suga M., Ando M., et al., Eosinophilic lung diseases: diagnostic accuracy of thin-section CT in 111 patients, Radiology, 2000, 216, 773–80 10.1148/radiology.216.3.r00se01773Search in Google Scholar PubMed
[39] Samman Y.S., Wali S.O., Abdelaal M.A., Gangi M.T., Krayem A.B., Chronic eosinophilic pneumonia presenting with recurrent massive bilateral pleural effusion: case report, Chest, 2001, 119, 968–70 http://dx.doi.org/10.1378/chest.119.3.96810.1378/chest.119.3.968Search in Google Scholar PubMed
[40] Mayo J.R., Muller N.L., Road J., Sisler J., Lillington G., Chronic eosinophilic pneumonia: CT findings in six cases, A. J. R., 1989, 153, 727–30 10.2214/ajr.153.4.727Search in Google Scholar PubMed
[41] Franquet T., Imaging of pneumonia: trends and algorithms, Eur. Respir. J., 2001, 18, 196–208 http://dx.doi.org/10.1183/09031936.01.0021350110.1183/09031936.01.00213501Search in Google Scholar PubMed
[42] Woodhead M., Blasi F., Ewig S., Huchon G., Leven M., Ortqvist A., et al., Guidelines for the management of adult lower respiratory tract infections, Eur. Respir. J., 2005, 26, 1138–80 http://dx.doi.org/10.1183/09031936.05.0005570510.1183/09031936.05.00055705Search in Google Scholar PubMed
[43] Lazor R., Vandevenne A., Pelletier A., Leclerc P., Court-Fortune I., Cordier J-F., Cryptogenic organizing pneumonia. Characteristics of relapses in a series of 48 patients, Am. J. Respir. Crit. Care Med., 2000, 162, 571–7 10.1164/ajrccm.162.2.9909015Search in Google Scholar PubMed
[44] Laufs U., Schneider C., Wassermann K., Erdmann E., Chronic eosinophilic pneumonia with atypical radiographic presentation, Respiration, 1998, 65, 323–6 http://dx.doi.org/10.1159/00002928710.1159/000029287Search in Google Scholar PubMed
[45] Azuma M., Nakamura Y., Sano T., Okano Y., Sone S., Adhesion molecule expression on eosinophils in idiopathic eosinophilic pneumonia, Eur. Respir. J., 1996, 9, 2494–500 http://dx.doi.org/10.1183/09031936.96.0912249410.1183/09031936.96.09122494Search in Google Scholar PubMed
[46] Shijubo N., Fujishima T., Morita S., Nakata H., Satoh M., Uno E., et al. Idiopathic chronic eosinophilic pneumonia associated with noncaseating epithelioid granulomas, Eur. Respir. J., 1995, 8, 327–30 http://dx.doi.org/10.1183/09031936.95.0802032710.1183/09031936.95.08020327Search in Google Scholar PubMed
[47] Ashitani J., Matsumoto N., Nakazato M., Elevated levels of antimicrobial peptides in bronchoalveolar lavage fluid in patients with chronic eosinophilic pneumonia, Respiration, 2007, 74, 69–75 http://dx.doi.org/10.1159/00009019910.1159/000090199Search in Google Scholar PubMed
[48] Saita N., Yamanaka T., Kohrogi H., Ando M., Hirashima M., Apoptotic response of eosinophils in chronic eosinophilic pneumonia, Eur. Respir. J. 2001, 17, 190–4 http://dx.doi.org/10.1183/09031936.01.1720190010.1183/09031936.01.17201900Search in Google Scholar PubMed
[49] Shijubo N., Shigehara K., Hirasawa M., Inuzuka M., Abe S., Eosinophilic cationic protein in chronic eosinophilic pneumonia and eosinophilic granuloma, Chest, 1994, 106, 1481–6 http://dx.doi.org/10.1378/chest.106.5.148110.1378/chest.106.5.1481Search in Google Scholar PubMed
[50] Giembycz M.A., Lindsay M.A., Pharmacology of the eosinophil, Pharm. Rev., 1999, 51, 213–39 Search in Google Scholar
[51] Yoshida K., Shijubo N., Koba H., Mori Y., Satoh M., Morikawa T., et al. Chronic eosinophilic pneumonia progressing to lung fibrosis, Eur. Respir. J., 1994, 7, 1541–4 http://dx.doi.org/10.1183/09031936.94.0708154110.1183/09031936.94.07081541Search in Google Scholar PubMed
[52] Solans R., Bosch J.A., Perez-Bocanegra C., Selva A., Huguet P., Alijotas J., et al., Churg-Strauss syndrome: outcome and long-term follow-up of 32 patients, Rheumatol., 2001, 40, 763–71 http://dx.doi.org/10.1093/rheumatology/40.7.76310.1093/rheumatology/40.7.763Search in Google Scholar PubMed
© 2009 Versita Warsaw
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
