Chronic eosinophilic pneumonia presenting with ipsilateral pleural effusion: a case report

Abstract

BackgroundChronic eosinophilic pneumonia is a rare idiopathic interstitial lung disease. The nearly pathognomonic radiographic finding is the peripheral distribution of alveolar opacities. Pleural effusions are rarely seen. We report a case of chronic eosinophilic pneumonia with transudative eosinophilic pleural effusion.Case presentationA 57-year-old Hispanic woman, a nonsmoker with a history of controlled asthma, presented to the hospital with unresolving pneumonia despite three rounds of antibiotics over a 2-month period. She was later diagnosed with chronic eosinophilic pneumonia based on the presence of peripheral blood eosinophilia, the peripheral distribution of alveolar infiltrates on chest radiograph, and a lung parenchymal biopsy with infiltrates of eosinophils. Upon presentation, our patient had a right-sided moderate-sized pleural effusion. The pleural fluid profile was consistent with a transudative effusion with eosinophil predominance. Our patient responded promptly to oral corticosteroid treatment in a few days. The pulmonary infiltrates and pleural effusion subsided on a 1-month follow-up chest radiograph after starting corticosteroid treatment.ConclusionsWe report the first case of chronic eosinophilic pneumonia presenting with pneumonia with ipsilateral transudative eosinophilic pleural effusion. Like other cases of chronic eosinophilic pneumonia, early recognition and diagnosis is essential and prompt treatment with corticosteroids is the mainstay of therapy. Pleural effusion resolved without the further need for therapeutic thoracentesis.

Diagnostic procedure for idiopathic eosinophilic pleural effusion: a single-center experience

“…Among these cases, 7 had bilateral effusion and 4 had lung involvement. Previous reports [12][13][14][15][16] showed the eosinophils were always significantly elevated, reaching up to 3.5 × 10 9 /L. Contrarily, in this study, the number of eosinophils were normal or slightly elevated.…”

“…Moreover, fever, productive cough, fatigue, lymphadenopathy, splenomegaly and ascites often exist [7,8]. Most patients had bilateral pleural effusion [11][12][13]15], but unilateral effusion was also evident [14]. We found all 11 patients developed respiratory symptoms which are similar to IEPE symptoms.…”

“…EPEs account for 5 to 16% of the exudative pleural effusions, and IEPE is an important cause of EPEs which can almost always be treated medically [7,8]. However, welldocumented cases are limited [12][13][14][15][16]. In this study, we tried to analyse the clinical characteristics of IEPE and to clarify the diagnostic procedure.…”

“…Although IEPE has been regarded as an important cause of EPE, few prospective studies are available [12][13][14][15][16]. The clinical characteristics and diagnostic approach for IEPE have remained unclear to physicians.…”

Diagnostic procedure for idiopathic eosinophilic pleural effusion: A single-center experience

“…Although IEPE has been regarded as an important cause of EPE, few prospective studies are available [7][8][9][10][11] . The clinical characteristics and diagnostic approach for IEPE remain not quite clear to physicians.…”