The Eosinophilic Pneumonias

James N. Allen; Cynthia M. Magro; Mark A. King

doi:10.1055/s-2002-25301

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2002; 23(2): 127-134
DOI: 10.1055/s-2002-25301

The Eosinophilic Pneumonias

James N. Allen¹ , Cynthia M. Magro² , Mark A. King³

¹Department of Internal Medicine, Columbus, Ohio
²Department of Pathology, Columbus, Ohio
³Department of Radiology, Columbus, Ohio

Abstract

ABSTRACT

Acute and chronic eosinophilic pneumonia can be distinguished by their clinical, laboratory, and radiographic features. Patients with both acute and chronic eosinophilic pneumonia present with cough, dyspnea, and fever. Patients with chronic eosinophilic pneumonia present subacutely over weeks to months but patients with acute eosinophilic pneumonia present within 5 days of symptom onset. Chest radiographs in chronic eosinophilic pneumonia show peripheral alveolar infiltrates. In contrast, radiographs in acute eosinophilic pneumonia show mixed interstitial and alveolar infiltrates, Kerley B lines, and pleural effusions. Both disorders are characterized by high percentages of bronchoalveolar lavage eosinophils, but high numbers of blood eosinophils accompanies only chronic eosinophilic pneumonia. The diagnosis of both disorders can usually be made based on clinical and radiographic findings; however, lung biopsy is occasionally necessary to distinguish the eosinophilic pneumonias from other eosinophilic lung diseases. In both conditions, patients will respond rapidly and completely to corticosteroids but patients with chronic eosinophilic pneumonia usually relapse if less than 6 months of treatment is given, whereas patients with acute eosinophilic pneumonia do not relapse after a brief course of treatment.

KEYWORD

Eosinophil - eosinophilic pneumonia - Charcot-Leyden crystals

Full Text

References

REFERENCES

1 Allen J N, Davis W B. State of the art: the eosinophilic lung diseases. Am J Respir Crit Care Med . 1994; 150 1423-1438
2 Allen J N, Davis W B, Pacht E R. Diagnostic significance of increased bronchoalveolar lavage fluid eosinophils. Am Rev Respir Dis . 1990; 142 642-647
3 Christoforidis A J, Molnar W. Eosinophilic pneumonia: report of two cases with pulmonary biopsy. JAMA . 1960; 173 157-161
4 Carrington C B, Addington W W, Goff A M. Chronic eosinophilic pneumonia. N Engl . 1969; 280 787-798
5 Jederlinic P J, Sicilian L, Gaensler E A. Chronic eosinophilic pneumonia: a report of 19 cases and a review of the literature. Medicine . 1988; 154-162
6 Marchand E, Reynaud-Gaubert M, Lauque D, Durieu J, Tonnel A-B, Cordier J-F. Idiopathic chronic eosinophilic pneumonia: a clinical and follow-up study of 62 cases. Medicine . 1998; 77 299-312
7 Gaensler E A, Carrington C B. Peripheral opacities in chronic eosinophilic pneumonia: the photographic negative of pulmonary edema. Am J Roentgenol . 1977; 128 1-13
8 Johkoh T, Muller N L, Akira M. Eosinophilic lung diseases: diagnostic accuracy of thin-section CT in 111 patients. Radiology . 2000; 216 773-780
9 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. Am J Roentgenol . 2001; 176 1053-1058
10 Liebow A A, Carrington C B. The eosinophilic pneumonias. Medicine (Baltimore) . 1969; Jul;48(4) 251-285
11 Kanner R E, Hammar S P. Chronic eosinophilic pneumonia: ultrastructural evidence of marked immunoglobulin production plus macrophagic ingestion of eosinophils and eosinophilic lysosomes leading to intracytoplasmic Charcot-Leyden crystals. Chest . 1977; 71 95-98
12 Shijubo N, Fujishima T, Morita S. Idiopathic chronic eosinophilic pneumonia associated with noncaseating epithelioid granulomas. Eur Respir J . 1995; 8 327-330
13 Enrique E, Aguilar X, Magarolas R. Cavitated chronic eosinophilic pneumonia with increased serum IgE: is its differentiation from Churg-Strauss vasculitis possible?. Arch Brononeumol . 1998; 34 364-365
14 Cooney T P. Interrelationship of chronic eosinophilic pneumonia, bronchiolitis obliterans and rheumatoid disease: a hypothesis. J Clin Pathol . 1981; 149 129-137
15 Olopade C O, Crotty T B, Douglas W W, Colby T V, Sur S. Chronic eosinophilic pneumonia and idiopathic bronchiolitis obliterans organizing pneumonia: comparison of eosinophil number and degranulation by immunofluorescence staining for eosinophil-derived major basic protein. Mayo Clin Proc . 1995; 70 137-142
16 Lai R S, Lin S L, Lai N S, Lee P C. Churg-Strauss syndrome presenting with pulmonary capillaritis and diffuse alveolar hemorrhage. Scan J Rheumatol . 1998; 27 230-232
17 Basset F, Ferrans V J, Soler P, Takemura T, Fukuda Y, Crystal R G. Intraluminal fibrosis in interstitial lung disorders. Am J Pathol . 1986; 122 443-461
18 Phunmanee A, Boonsawat W, Charoensiri D J, Limkunacul C. Chronic eosinophilic pneumonia: a case report. J Med Assoc Thai . 2000; 83 959-963
19 Fox B, Seed W A. Chronic eosinophilic pneumonia. Thorax . 1980; 35 570-580
20 Perrault J L, Janis M, Wolinsky H. Resolution of chronic eosinophilic pneumonia with corticosteroid therapy: demonstration by needle biopsy. Ann Intern Med . 1971; 74 951-954
21 Badesch D B, King T E, Schwarz M I. Acute eosinophilic pneumonia: a hypersensitivity phenomenon?. Am Rev Respir Dis . 1989; 139 249-252
22 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; 321 569-574
23 Hayakawa H, Sato A, Toyoshima M, Imokawa S, Taniguchi M. A clinical study of idiopathic eosinophilic pneumonia. Chest . 1994; 105 1462-1466
24 Pope-Harman A L, Davis W B, Christoforidis A J, Allen E D, Allen J N. Acute eosinophilic pneumonia: a summary of fifteen cases and review of the literature. Medicine . 1966; 75 334-342
25 Shintani H, Fujimura M, Ishiura Y, Noto M. A case of cigarette smoking-induced acute eosinophilic pneumonia showing tolerance. Chest . 2000; 117 277-279
26 Maeno T, Maeno Y, Sando Y. Nuclear hypersegmentation precedes the increase in blood eosinophils in acute eosinophilic pneumonia. Intern Med . 2000; 39 157-159
27 Ogawa H, Fujimura M, Matsuda T, Nakamura J, Kumabashiri I, Kitagawa S. Transient wheeze: eosinophilic bronchiolitis in acute eosinophilic pneumonia. Chest . 1993; 104 493-496
28 King M A, Pope-Harman A, Allen J N, Christoforidis G A, Christoforidis A J. Acute eosinophilic pneumonia: radiologic and clinical features. Radiology . 1997; 203 715-719
29 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; 92 743-749
30 Ricker D H, Taylor S R, Gartner Jr C J, Kurland G. Fatal pulmonary aspergillosis presenting as acute eosinophilic pneumonia in a previously healthy child. Chest . 1991; 100 875-877
31 Barnes M T, Bascunana J, Garcia B, Alvarez-Sala J L. Acute eosinophilic pneumonia associated with antidepressant therapy. Pharm World Sci . 1999; 21 241-242
32 Tazelaar H D, Linz L J, Colby T V, Myers J L, Limper A H. Acute eosinophilic pneumonia: histopathologic findings in nine patients. Am J Respir Crit Care Med . 1997; 155 296-302