Early-phase Neutrophilia in Cigarette Smoke-induced Acute Eosinophilic Pneumonia

Abstract

Although cigarette smoking is a recognized cause of acute eosinophilic pneumonia (AEP), and an increase in eosinophils in the lung is a common occurrence in AEP, early-phase neutrophilia in AEPis not well understood. Wedescribe three cases of cigarette smoke (menthol type)-induced AEP with neutrophilia in the lungs or blood. Increased in-vitro production of the neutrophil chemoattractant interleukin (IL)-8 by human bronchial epithelial cells (HBECs) was correlated with neutrophilia. Wesuggest that IL-8 released from HBECs is involved in neutrophilia in the lung in AEP, and is newly recognized as an important factor in the early phase of AEPdevelopment. (Internal Medicine 42: 839-845, 2003)

Palatine tonsils in smoker and non‐smoker patients: a pilot clinicopathological and ultrastructural study

“…Numerous studies provide evidence of impairment of cell‐mediated immunity induced by tobacco smoke. Altered neutrophilic, fibroblastic and lymphocytic activity, decrease of pulmonary dendritic cells, increased number of neutrophils and monocytes along with large amount of proteases and altered secretion of regulatory cytokines have been reported (27–30). Such findings are consistent with an imbalance in tobacco smoke‐induced immune response leading to chronic inflammatory diseases as well as contributing to tumour induction and development.…”

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

“…However, FeNo is not readily available and so was not used in this case. Patients with AEP usually present with initial neutrophilic leukocytosis rather than eosinophilia, which makes early suspicion more difficult 11. Although peripheral blood eosinophilia was detected in the blood of the present patient, it was not a strong stimulus for us to proceed with bronchoscopy.…”

Answer

“…At presentation the patient had increased peripheral blood neutrophils, a phenomenon previously reported in cigarette smoke-induced AEP 4. While peripheral blood eosinophilia characteristically does not occur during the acute phase of AEP, levels may become quite high during convalescence before normalising 2.…”

“…Environmental, occupational and recreational exposures are thought to play a significant role in the pathogenesis of AEP. A number of authors have described the development of AEP shortly after the onset of smoking 1 3 4. AEP has also been reported in a patient who became symptomatic shortly after participating in a bicycle race “in dusty conditions” 5.…”