Eosinophilic pneumonias

Abstract

Eosinophilic pneumonias (EP) encompass a wide spectrum of lung diseases characterized by peripheral blood eosinophilia (>1 × 109 eosinophils/l) and/or alveolar eosinophilia (>25%). Blood eosinophilia may be lacking, as in the early phase of idiopathic acute EP, or in patients already taking oral corticosteroids. EP may present with varying severity, ranging from almost asymptomatic infiltrates to the acute respiratory distress syndrome necessitating mechanical ventilation. Possible causes of EP must be thoroughly investigated, especially drugs and the variety of parasitic infections (considering history of travel or residence in areas of endemic parasitic infection). However, chronic EP remains idiopathic in many cases. When present, extrathoracic manifestations lead to suspect Churg–Strauss syndrome (CSS) or the hypereosinophilic syndrome (HES), the prognosis of which is dominated by cardiac involvement. Apart from the treatment of specific causes when possible, corticosteroids remain the cornerstone of symptomatic treatment for eosinophilic disorders, usually with a dramatic response, but frequent relapses when tapering or after stopping the treatment. The adjunction of immunosuppressants to corticosteroids is necessary in patients with CSS and poor prognosis factors. Imatinib has recently proven effective in the treatment of the myeloproliferative variant of the HES.

Padrões tomográficos das doenças intersticiais pulmonares difusas com correlação clínica e patológica

“…It has been suggested that a differential cell count of greater than 40% eosinophils in the BAL fluid is diagnostic of CEP. (105) The symptoms are similar to those found in COP (fever, weight loss, night sweats, cough, and dyspnea), evolving over weeks or months. Asthma antedates the diagnosis in 50% of the cases.…”

“…Examination of the stool for ova and parasites is important. (105) It is not uncommon for CEP to be misdiagnosed as bacterial pneumonia. The hallmark of CEP is a rapid, dramatic response to oral corticosteroids.…”

Chronic Eosinophilic Pneumonia in a Breast Cancer Patient Post-Radiation Therapy: A Case Report

“…1 The proposed mechanism is priming followed by an antigenic stimulation. 1,12 The patient presented is a runner, thus putting her at high risk of exposure to environmental allergens.…”

Pneumonia eosinofílica crónica idiopática – A propósito de um caso clínico

“…Alguns doentes relatam antecedentes de "pneumonia" recorrente resistente à antibioterapia 8 . O exame objectivo é geralmente inespecífi-co, expressando -se em cerca de 1/3 dos doentes por sibilância ou crepitações à auscultação pulmonar 8,9 . 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 .…”

“…Pelo que diz respeito ao estudo funcional, a PECI caracteriza -se por um distúrbio ventilatório restritivo, moderado a grave, podendo ocorrer obstrução, sugerindo bronquiolite associada ou mesmo síndroma de Churg--Strauss 10 . Existe distúrbio da difusão dos gases através da membrana alveolocapilar, evidenciado por uma PaO 2 inferior a 60 mmHg em cerca de 2/3 dos doentes, associada geralmente a hipocapnia e redução da DLCO em 50% dos doentes 9,13 . Contudo, cerca de 1/3 dos doentes pode manter uma função pulmonar normal 6 .…”