Eosinophilic Lung Disease

Weissler, Jonathan C.

doi:10.1016/j.amjms.2017.03.020

Cited by 28 publications

(39 citation statements)

References 96 publications

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“…In humans, eosinophilic lung disease has many different forms that often are divided into disorders that affect the airways, those that involve the alveolar space, and those that are part of a systemic response . Variants of airway disease include asthma and allergic bronchopulmonary aspergillosis (ABPA), a form of asthma characterized by hypersensitivity to Aspergillus .…”

Section: Discussionmentioning

confidence: 99%

Eosinophilic bronchitis, eosinophilic granuloma, and eosinophilic bronchopneumopathy in 75 dogs (2006‐2016)

Johnson

Hulsebosch

et al. 2019

Veterinary Internal Medicne

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Background Eosinophilic lung disease is a poorly understood inflammatory airway disease that results in substantial morbidity. Objective To describe clinical findings in dogs with eosinophilic lung disease defined on the basis of radiographic, bronchoscopic, and bronchoalveolar lavage fluid (BAL) analysis. Categories included eosinophilic bronchitis (EB), eosinophilic granuloma (EG), and eosinophilic bronchopneumopathy (EBP). Animals Seventy‐five client owned dogs. Methods Medical records were retrospectively reviewed for dogs with idiopathic BAL fluid eosinophilia. Information abstracted included duration and nature of clinical signs, bronchoscopic findings, and laboratory data. Thoracic radiographs were evaluated for the pattern of infiltrate, bronchiectasis, and lymphadenomegaly. Results Thoracic radiographs were normal or demonstrated a bronchial pattern in 31 dogs assigned a diagnosis of EB. Nine dogs had intraluminal mass lesions and were bronchoscopically diagnosed with EG. The remaining 35 dogs were categorized as having EBP based on radiographic changes, yellow green mucus in the airways, mucosal changes, and airway collapse. Age and duration of cough did not differ among groups. Dogs with EB were less likely to have bronchiectasis or peripheral eosinophilia, had lower total nucleated cell count in BAL fluid, and lower percentage of eosinophils in BAL fluid compared to dogs in the other 2 groups. In contrast to previous reports, prolonged survival (>55 months) was documented in dogs with EG. Conclusions and Clinical Importance Dogs with eosinophilic lung disease can be categorized based on imaging, bronchoscopic and BAL fluid cytologic findings. Further studies are needed to establish response to treatment in these groups.

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Section: Discussionmentioning

confidence: 99%

Eosinophilic bronchitis, eosinophilic granuloma, and eosinophilic bronchopneumopathy in 75 dogs (2006‐2016)

Johnson

Hulsebosch

et al. 2019

Veterinary Internal Medicne

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“…ELD can be diagnosed in the presence of thoracic opacifications associated with blood eosinophilia, parenchymal eosinophilia confirmed by pulmonary biopsy and important eosinophilia confirmed by BAL. They are divided into diseases with known cause (parasitic infection, allergic bronchopulmonary aspergillosis or drug toxicity), with unknown cause (Loeffler syndrome, acute (AEP) and CEP or idiopathic hypereosinophilic syndrome), and eosinophilic vasculitis (eosinophilic granulomatosis with polyangiitis previously known as Churg–Strauss syndrome) 8…”

Section: Discussionmentioning

confidence: 99%

<p>A case of chronic eosinophilic pneumonia in a patient treated with dupilumab</p>

Menzella¹,

Montanari²,

Patricelli³

et al. 2019

TCRM

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The increasing knowledge on inflammatory pathways has driven the development of targeted biological therapies for severe refractory asthma. Among the recently developed biologics, the fully human monoclonal antibody dupilumab is an interesting therapeutic option, given its ability to inhibit the biological effects of both IL-4 and IL-13. We describe the case of a male, Caucasian, 56-year-old patient with allergic and eosinophilic severe asthma. Given the poor asthma control, he started treatment with add-on dupilumab, and after the tenth injection, he presented with a fever and bilateral pulmonary thickening. A significant increase in blood eosinophilia was also reported. The patient underwent a fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB/TBB). BAL revealed eosinophils alveolitis (60%) while TBB showed findings compatible with chronic eosinophilic pneumonia (CEP). After prolonged treatment with oral corticosteroids, the clinical picture improved with resolution of CEP. Since the beginning of dupilumab treatment, simultaneously to a great improvement in asthma control, the patient showed a progressive increase in blood eosinophils count and subsequent onset of clinical-radiological pattern suggestive of CEP. Based on published data, dupilumab may have induced an alteration of the complex immunological pathway of our patient. This pathway is affected by both allergic and eosinophilic asthmatic endotypes, and consequently, the concomitant action of allergenic stimuli and eosinophils may have caused the appearance of eosinophilic pneumonia. To our knowledge, this is the first reported case of CEP as a possible severe side effect of dupilumab administration.

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“…In the diagnostic management of ELD, a known etiology could be found (parasitic infection, allergic bronchopulmonary aspergillosis, drug toxicity), while also unknown causes (Loeffler syndrome, acute or chronic eosinophilic pneumonia, idiopathic hypereosinophilic syndrome) and eosinophilic vasculitis (EGPA, formerly known as Churg–Strauss syndrome) could cause these diseases. 9 …”

Section: Discussionmentioning

confidence: 99%

<p>May 2020: Is It Always COVID-19 No Matter What?</p>

Livrieri¹,

Ghidoni²,

Piro³

et al. 2020

IMCRJ

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing a massive outbreak throughout the world. In this period, diseases other than coronavirus disease (COVID-19) have not disappeared; however, it is hard for doctors to diagnose diseases that can mimic the clinical, radiological, and laboratory features of COVID-19, especially rare lung diseases such as acute eosinophilic pneumonia (AEP). We report the clinical case of a young patient who presented to the Emergency Department with respiratory failure and clinical symptoms, radiological aspects, and blood tests compatible with COVID-19; two swabs and a serology test for SARS-CoV-2 were performed, both resulted negative, but the respiratory failure worsened. Peripheral eosinophilia guided us to consider the possibility of a rare disease such as AEP, even if radiology findings were not pathognomonic. Therefore, we decided to perform a flexible bronchoscopy with bronchoalveolar lavage (BAL) at the lingula, which showed the presence of eosinophilia greater than 40%. As a consequence, we treated the patient with high-dose corticosteroids that completely resolved the respiratory symptoms. This case report highlights the difficulty of making alternative diagnoses during the COVID-19 pandemic, especially for rare lung diseases such as AEP, which may have initial characteristics similar to COVID-19.

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Eosinophilic Lung Disease

Cited by 28 publications

References 96 publications

Eosinophilic bronchitis, eosinophilic granuloma, and eosinophilic bronchopneumopathy in 75 dogs (2006‐2016)

Eosinophilic bronchitis, eosinophilic granuloma, and eosinophilic bronchopneumopathy in 75 dogs (2006‐2016)

<p>A case of chronic eosinophilic pneumonia in a patient treated with dupilumab</p>

<p>May 2020: Is It Always COVID-19 No Matter What?</p>

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