Sertraline-Induced Acute Eosinophilic Pneumonia

Abstract

Acute eosinophilic pneumonia (AEP) is a rare but severe respiratory syndrome characterized by fever, hypoxemic respiratory failure, diffuse pulmonary infiltrates, and pulmonary eosinophilia. The most common cause of AEP is idiopathic, but it can be associated with antidepressant medications like sertraline.A 76-year-old female presented to our ED with acute hypoxemic respiratory failure. She had no history of smoking or prior lung disease. She did not improve after treatment with broad spectrum antibiotics so a trial of corticosteroids was initiated. Her work-up was negative for infectious or collagen vascular causes of the respiratory failure. She was diagnosed with AEP associated with sertraline. Her condition improved with corticosteroid therapy after discontinuation of sertraline. This case report highlights AEP as a possible adverse reaction of sertraline. Prompt discontinuation of the offending drug is necessary for early recovery.

Hypereosinophilia and Cognitive Impairment Induced by Mirtazapine

“…The presence of these conditions are secondary to prescriptions for antidepressants including fluoxetine, amitriptyline, and desipramine; anticonvulsants including phenytoin, valproate, lamotrigine, and carbamazepine; antibiotics including penicillins, cephalosporins, and quinolones; nonsteroidal anti-inflammatory drugs including naproxen, diclofenac, and ibuprofen; antihypertensive agents including angiotensin-converting enzyme inhibitors, b-blockers, and hydrochlorothiazide; and sulfasalazine and allopurinol. [2][3][4] In addition, several studies have reported eosinophilia or hypereosinophilia related to psychotropic drugs such as paroxetine, sertraline, venlafaxine, duloxetine, 5 lithium, olanzapine, 3 clozapine, 4 quetiapine, risperidone, 6 ziprasidone, 7 and aripiprazole. 8 However, mirtazapine has not yet been reported.…”

“…5 In addition, serotonin also has a chemoattractant factor for eosinophils through expressed 5-HT 2A receptor, then mediates eosinophil recruitment, and leads to an inflammatory reaction and hypersensitivity. 5,10 Interestingly, the selective activation of 5-HT 2A receptors has potent antiinflammatory activity in animal models, preventing the development of eosinophil recruitment and migration by reducing IL-5 and granulocyte-macrophage colony-stimulating factor levels and monocyte chemoattractant protein-1 secretion. 11 Mirtazapine may be relevant because of its antagonistic effects on 5-HT 2A receptors.…”