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

Abstract

A 69-year-old female patient visited the emergency room with fever (38.3℃) 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.

Primary Eosinophilic Lung Diseases and the Therapeutic Role of Corticosteroids: A Case Report and Literature Review

“…However, inhaled steroids are not effective when prescribed as monotherapy and should be given in conjunction with oral steroids for symptomatic resolution (Minakuchi et al, 2003). There was only one unusual case report of a woman already on long-term prednisolone for rheumatoid arthritis who presented with AEP but dramatically improved with a single dose of HDMP (Shin et al, 2013).…”