Diagnostic Problems in Chronic Eosinophilic Pneumonia

Abstract

To identify the problems involved in the diagnosis of chronic eosinophilic pneumonia (CEP), clinical findings were analysed for 43 patients diagnosed clinically or pathologically with CEP during the past 10 years. About 28% of patients showed peripheral blood eosinophilia and a typical pattern of pulmonary oedema on chest X-ray at initial examination. Eosinophilia was demonstrated in peripheral blood in 86% of patients, in bronchoalveolar lavage (BAL) in 100%, and in transbronchial lung biopsy (TBLB) specimens in 64% of patients. Peripheral blood tests, BAL, and TBLB were all positive for eosinophilia in 60% of patients. BAL was the single test most likely to be positive among the diagnostic tests used in the present study. When CEP is suspected clinically, an understanding of which site is examined by each of the diagnostic tests and of the likelihood of a positive result in each test will facilitate the selection of the most appropriate tests for individual patients.

A Curious Case of Chronic Eosinophilic Pneumonia

“…Severe illness is characterized by high fever, weight loss, night sweats, and shortness of breath. Cough is nearly universal as well as dyspnea, but respiratory failure is rare [4][5][6]. Non-pulmonary symptoms (aside from fever, fatigue, and weight loss) are uncommon.…”

“…Fewer than 10 % of patients resolve spontaneously and the symptoms commonly recur with discontinuation within 6 months [1]. Additionally, untreated cases can progress to irreversible fibrotic changes in the lung [8].There is no consensus on the dose and duration of treatment, but most authors recommend initial doses of prednisone at 0.5-1 mg/kg/day with gradual tapering of the dose for total treatment duration of 6-12 months [4][5][6][7][8].…”

Die chronische idiopathische eosinophile Pneumonie – eine diagnostische Herausforderung

“…Der Nachweis von zirkulierenden Immunkomplexen wird allenfalls einem Epiphä-nomen zugeschrieben [12]. Der endoskopische bronchiale Befund ist meist unauffällig, entscheidend für die Diagnose der chronischen eosinophilen Pneumonie ist hierbei die bronchoalveoläre Lavage mit einer Eosinophilie von 20-30% bis maximal 95% [34,39,51]. Selten führt erst die offene Lungenbiopsie zur Diagnose [35].…”

Pneumonia eosinofílica crónica idiopática – A propósito de um caso clínico

“…A eosinofilia na expectoração e no LLBA é frequente, porém a eosinofilia periférica e uma IgE sérica elevada não estão presentes em todos os casos 10 . Eosinofilia sanguínea (>6%) é demonstrada em 60% a 90% dos doentes, enquanto a do LLBA (>40%) ocorre geralmente em todos os casos 11 . Analiticamente, há elevação da VS (> 60 mm/1.ªh) e da PCR 12 .…”