June 2107 pulmonary case of the month

Horsley, Robert; Wesselius, Lewis

doi:10.13175/swjpcc063-17

Cited by 3 publications

(11 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Pulmonary eosinophilia as demonstrated by eosinophil count comprising greater than 25% of BAL fluid leukocytes is a common finding in AEP, which obviates the need for a lung biopsy [3]. Pulmonary eosinophilia as demonstrated by BAL fluid analysis was notably absent in our patient but clinched the diagnosis in the other three case reports highlighted above [5][6][7]. We suspect that the absence of BAL fluid eosinophils in our case was secondary to the administration of steroids soon after hospital admission, a little more than 48 hours before bronchoscopy was pursued.…”

Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

“…Four cases of eosinophilic pneumonia have been reported with the use of injectable naltrexone [4][5][6][7]. Three of these cases have been described as case reports in the medical literature [5][6][7]. The patient's presentation in Kim et al's case report was consistent with chronic eosinophilic pneumonia, whereas the patient's presentation in Horsley and Wesselius's and Esposito et al's case reports were in keeping with AEP [5][6][7].…”

Section: Discussionmentioning

confidence: 99%

“…Three of these cases have been described as case reports in the medical literature [5][6][7]. The patient's presentation in Kim et al's case report was consistent with chronic eosinophilic pneumonia, whereas the patient's presentation in Horsley and Wesselius's and Esposito et al's case reports were in keeping with AEP [5][6][7]. Our patient met all the criteria included in the modified Philit criteria for the diagnosis of "definite" AEP [3].…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

A Case for Biopsy: Injectable Naltrexone-Induced Acute Eosinophilic Pneumonia

Korpole

Al-Bacha

Hamadeh

2020

Cureus

View full text Add to dashboard Cite

Naltrexone is a semi-synthetic opioid that has competitive antagonist activity at mu opioid receptors. Naltrexone has proven to be efficacious in the treatment of alcohol and opioid dependence, and a long-acting injectable form of naltrexone was developed to overcome noncompliance. Therefore, injectable naltrexone has the potential to become an important medication for the treatment of opiate and alcohol dependence. Acute eosinophilic pneumonia (AEP) is a rare acute respiratory illness of varying severity that may lead to acute respiratory distress syndrome and death. Initially, AEP was thought to be idiopathic; however, it has become apparent that AEP can have identifiable causes including medications, infections, and other inhalational exposures, especially tobacco smoke. AEP is generally a diagnosis of exclusion confirmed by the presence of bronchoalveolar lavage (BAL) fluid eosinophilia. Recognition and elimination of the causative factor for AEP and providing glucocorticoid therapy are key principles in the management of AEP of non-infectious origin. Prognosis is generally excellent if AEP is diagnosed early and managed appropriately, even in patients with acute respiratory failure. The diagnosis of AEP is generally overlooked given the shared clinical attributes with acute lung injury due to other causes, including severe community-acquired pneumonia. A 32-year-old lady presented to the emergency department (ED) with symptoms of dyspnea, chest pain, cough, and subjective fevers since three days. She received a dose of intramuscular Naltrexone for the treatment of alcohol and opiate dependence on the day of symptom onset. Initially, she was noted to be hypoxic, and oxygen supplementation was initiated through a nasal cannula. While in the ED, she was placed on a non-rebreather mask because of worsening hypoxia. Chest imaging showed diffuse bilateral pulmonary infiltrates. Initial laboratory data were pertinent for elevated WBC count with mild peripheral eosinophilia. Antibiotics were administered for the treatment of suspected community-acquired pneumonia. Upon hospital admission, she was started on steroids for the management of suspected eosinophilic pneumonia secondary to injectable naltrexone. Bronchodilator therapy was initiated, and antibiotics were discontinued. The patient's oxygen requirements improved. Pulmonology consultation was requested, and the patient underwent bronchoscopy. BAL studies showed predominance of lymphocytes with no eosinophils. However, lung biopsy showed findings consistent with drug-induced eosinophilic pneumonitis. The patient's hypoxia resolved with steroid therapy. The patient was discharged with a course of oral steroids, albuterol inhaler, and outpatient pulmonology follow-up.

show abstract

Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A Case for Biopsy: Injectable Naltrexone-Induced Acute Eosinophilic Pneumonia

Korpole

Al-Bacha

Hamadeh

2020

Cureus

View full text Add to dashboard Cite

show abstract

“…AEP can be associated with many identifiable causes including cigarette smoke most notably, as well as other inhalants, infections, and medications. Although antibiotics and nonsteroidal anti-inflammatory drugs are among the more common inciting medications, injectable naltrexone has been implicated in several case reports (3,5,6,7). The clinical presentations of AEP can mimic SARS-CoV-2 pneumonia, communityacquired pneumonia, or ARDS; hence, a high index of clinical suspicion is essential to avoid delay in therapy.…”

Section: Case Presentationmentioning

confidence: 99%

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

Breuer¹,

Ali²

2022

Southwest J Pulm Crit Care Sleep

View full text Add to dashboard Cite

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 …

show abstract

A case of naltrexone-induced acute eosinophilic pneumonia

Abdelghany,

Glick,

Cutler

2024

BMJ Case Rep

View full text Add to dashboard Cite

Acute eosinophilic pneumonia (AEP) is a rare cause of acute respiratory failure. Clinical presentations can range from dyspnoea, fever and cough, to rapidly progressive and potentially fulminant respiratory failure. While its exact cause is often unknown, associations with inhalational injuries and exposures to new medications have been described.We report a case of a middle-aged, non-smoking man with a history of alcohol use disorder. He presented with 4 days of shortness of breath that started hours after taking injectable naltrexone (Vivitrol). The patient had rapidly worsening hypoxaemia, necessitating emergent bronchoscopy with transbronchial biopsies and bronchoalveolar lavage which showed 66% eosinophils. The patient was intubated for the procedure and unable to get extubated due to worsening hypoxaemic respiratory failure with high fractional inspired oxygen requirements. Chest radiograph showed worsening lung infiltrates and with a high index of suspicion for AEP, he was started empirically on methylprednisolone. He had rapid improvement in his respiratory status and was extubated on day 5 of admission then discharged on day 8. Histopathological examination confirmed acute/subacute eosinophilic pneumonia. A 3-week post-discharge follow-up chest radiograph confirmed the full resolution of pulmonary infiltrates.Naltrexone-induced AEP is rare, with only six other cases reported in the literature. Careful history taking and prompt evaluation for AEP are important given the potential for rapid progression to acute hypoxic respiratory failure and the excellent response to steroid treatment.

show abstract

June 2107 pulmonary case of the month

Cited by 3 publications

References 2 publications

A Case for Biopsy: Injectable Naltrexone-Induced Acute Eosinophilic Pneumonia

A Case for Biopsy: Injectable Naltrexone-Induced Acute Eosinophilic Pneumonia

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

A case of naltrexone-induced acute eosinophilic pneumonia

Contact Info

Product

Resources

About