Acute Eosinophilic Pneumonia as a Reversible Cause of Noninfectious Respiratory Failure

J. N. Allen, E. R. Pacht, J. E. Gadek, W. B. Davis

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341 Scopus citations

Abstract

Although chronic eosinophilic pneumonia is a well-known disorder, acute eosinophilic pneumonia has not been as well characterized. We describe the clinical features, results of bronchoalveolar lavage, and follow-up studies of four patients with acute eosinophilic pneumonia. The patients presented with an acute febrile illness, severe hypoxemia (partial pressure of arterial oxygen <60 mm Hg), diffuse pulmonary infiltrates, an increased number of eosinophils (mean ±SEM, 42±4.8 percent) in bronchoalveolar-lavage fluid, and an absence of infection and previous atopic illness. The illness resolved rapidly after treatment with erythromycin and corticosteroids. The patients received doses of oral prednisone that were tapered over 10 days to 12 weeks, and none have relapsed since the steroids were discontinued. After a minimum follow-up period of five months, clinical evaluation, chest radiography, and pulmonary-function tests have shown no residual abnormalities attributable to the acute eosinophilic pneumonia. Follow-up bronchoalveolar lavage has demonstrated ≤1 percent eosinophils in all patients. We believe that we are describing an acute form of eosinophilic lung disease distinct from previously described syndromes. It can be diagnosed by bronchoalveolar lavage and seems to respond to treatment with corticosteroids. BRONCHOALVEOLAR lavage is a useful diagnostic and investigative technique in many acute and chronic lung diseases.1 2 3 4 5 6 7 It has also been used to study several of the pulmonary eosinophilic syndromes, including chronic eosinophilic pneumonia,8 9 10 11 12 13 14 15 parasitic infections,16 drug reactions,17 and airway disorders.18,19 Over the past two years, we have studied four patients with a distinct form of idiopathic lung disease presenting as acute respiratory failure. Our evaluation of these previously healthy patients found marked eosinophilia in fluid obtained by bronchoalveolar lavage. Infectious causes of lung disease were excluded, and there was prompt clinical resolution after corticosteroid therapy was begun. Recently, Badesch et…

Original languageEnglish (US)
Pages (from-to)569-574
Number of pages6
JournalNew England Journal of Medicine
Volume321
Issue number9
DOIs
StatePublished - Aug 31 1989

ASJC Scopus subject areas

  • Medicine(all)

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