Diagnostic Challenges of Acute Eosinophilic Pneumonia Post Naltrexone Injection Presenting During The COVID-19 Pandemic

Abstract

No abstract available. Article truncated after 150 words. Introduction Acute eosinophilic pneumonia (AEP) is a rare respiratory illness that may present with nonspecific symptoms ranging in severity from cough and dyspnea to potentially fatal acute respiratory distress syndrome. Although the exact etiology of AEP is unknown, it is thought to be a hypersensitivity reaction that can be idiopathic or caused by various infections, inhalation exposures, and medications (1). Here we present a rare case of AEP secondary to injectable naltrexone. Case Presentation A 45-year-old Caucasian male with a history of alcohol use disorder presented to the emergency room with a 3-day history of progressively worsening dyspnea and dry cough. The patient was a lifelong non-smoker with an unremarkable past medical history aside from alcohol abuse and obesity (BMI 41.64 kg/m²). He denied fever or chills, orthopnea, chest pain, or symptoms suggestive of paroxysmal nocturnal dyspnea. He also denied any recent sick contacts, including exposure to COVID-19. Relevant history …

A case of naltrexone-induced acute eosinophilic pneumonia

“…The fifth case was in 2022 when a middle-aged man presented with rapidly progressive respiratory failure post-naltrexone. This case has a very similar timeline to our patient and the patient had significant rapid improvement with steroids 6. Lastly, in 2023, the authors of this paper were able to diagnose a similar case of naltrexone-induced AEP using knowledge from this case in a very young woman who presented with dyspnoea and fever an hour after receiving the first dose of naltrexone to help with weight loss due to metabolic syndrome from anti-psychotic medications.…”

“…She was empirically treated with high-dose steroids given high concern for AEP and rapidly recovered 17. While all these cases share features of AEP including rapidly progressive respiratory failure after Vivitrol injection, with bilateral infiltrates on imaging and BAL eosinophilia, interestingly, not all patients developed it after first injection and some had it after second or third injection, raising concern for occurrence of this pneumonia even later in the course 3–6 8 16 17…”

“…Case reports in the past decade describe acute rapidly progressive eosinophilic pneumonia following injectable naltrexone administration 3–8. We report a case of acute hypoxic respiratory failure following a naltrexone injection for alcohol abstinence.…”