An unusual case of eosinophilic lung disease with multiple cyst formation

Abstract

We report here an unusual case of eosinophilic necrotizing inflammation of the lung that mimicked chronic eosinophilic pneumonia. A 71-year-old man who lived in an unsanitary environment and was referred to our hospital with suspected pneumonia. Peripheral blood eosinophilia was observed, and computed tomography indicated extensive consolidation with multiple cystic lesions, mainly in the left lung. A histological analysis using video-assisted thoracic surgery revealed diffuse infiltration of inflammatory cells into the alveolar wall and massive accumulation of macrophages and eosinophils in the airspace. Many tiny eosinophilic abscesses were scattered through the tissue. These findings were more severe than those associated with chronic eosinophilic pneumonia. Immunostaining revealed the deposition of eosinophil granular protein and the presence of extracellular traps and Charcot–Leyden crystals, which suggested excessive eosinophil activation. Interestingly, the patient's symptoms and clinical findings gradually improved without treatment after admission. He was discharged to a clean residence and did not have a recurrence for 19 months. The observations suggest a hypersensitivity reaction to an environmental allergen and consequent multiple cyst formation in association with eosinophilic necrotizing inflammation, although further studies are warranted.

Eosinophil granulocytes in chronic inflammatory respiratory diseases and CRSwNP: Function, immunological basis, and clinical significance

“…EET formation occurs independently of degranulation, although granule proteins have been detected on DNA strands [ 69 ]. The association of granule products with DNA has been suggested to occur both before [ 58 , 70 ] and after their release [ 71 ]. EETs have been shown to increase the viscosity of nasal secretions in patients with chronic rhinosinusitis [ 72 ].…”

Eosinophils—from cradle to grave

“…51,61 EET formation occurs independently of degranulation although granule proteins have been detected on DNA strands. 62 The association of granule products with DNA has been suggested both prior 51,63 and after its release. 64 It has been shown that EETs add to the viscosity of mucus in the nasal exudates of chronic rhinosinusitis (CRS) patients.…”

Galectin-10 as a Potential Biomarker for Eosinophilic Diseases

“…In the in vitro experimental setting, human eosinophils undergo cytolysis/ETosis by various stimuli, such as calcium ionophore, phorbol 12-myristate 13-acetate, IL-5/granulocyte macrophage colony-stimulating factor with platelet-activating factor, immobilized or aggregated Igs, autoantibodies, and fungi [ 57 , 60 , 61 , 62 , 63 , 64 ]. Eosinophil ETosis (EETosis) has been implicated in a wide range of eosinophilic diseases, such as asthma [ 65 , 66 ], allergic bronchopulmonary aspergillosis [ 67 , 68 ], eosinophilic otitis [ 61 , 69 ], eosinophilic chronic rhinosinusitis (chronic rhinosinusitis with nasal polyps) [ 61 ], hypereosinophilic syndrome [ 36 , 57 , 70 ], Wells syndrome (eosinophilic cellulitis) [ 71 ], eosinophilic granulomatosis with polyangiitis ([EGPA] Churg–Strauss syndrome) [ 72 , 73 ], eosinophilic pneumonia [ 74 , 75 , 76 ], ulcerative colitis [ 59 ], and chronic obstructive pulmonary diseases [ 77 ].…”