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Respiratory Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Ian Pavord, Nayia Petousi, Nick Talbot
A number of conditions are associated with pulmonary infiltration and a marked peripheral eosinophilia (Table 6.33). Eosinophilic pneumonia is the most common. Patients present with malaise, weight loss, night sweats, cough and breathlessness. Physical signs of lung disease are often absent but chest radiography shows a striking peripheral ground-glass change (the so-called photographic negative of pulmonary oedema). The condition is exquisitely responsive to oral corticosteroids and usually resolves after a 6-month course of tapering oral prednisolone.
Eosinophilic interstitial lung disorders
Published in Muhunthan Thillai, David R Moller, Keith C Meyer, Clinical Handbook of Interstitial Lung Disease, 2017
Vincent Cottin, Claudia Valenzuela
A lung biopsy is only performed in rare cases when the diagnosis of eosinophilic pneumonia has not been suspected. It shows acute and organizing diffuse alveolar damage together with interstitial alveolar and bronchiolar infiltration by eosinophils, intra-alveolar eosinophils and interstitial oedema.
Clinical Cases
Published in S. J. Copley, J. P. Kanne, D. M. Hansell, Thoracic Imaging, 2014
S. J. Copley, J. P. Kanne, D. M. Hansell
18i. The initial chest radiograph shows patchy bilateral areas of consolidation both peripherally and centrally located but with a right lower zone predominance. The subsequent radiograph shows a predominantly peripheral distribution of consolidation, with new areas in the right upper and left lower zone and other areas that have resolved. There is also right paratracheal adenopathy on the later radiograph. The clinical and radiographic features in this patient are compatible with the diagnosis of chronic eosinophilic pneumonia.
Two cases of rheumatoid arthritis complicated by organising pneumonia successfully treated with tofacitinib therapy
Published in Modern Rheumatology Case Reports, 2021
Takao Kodera, Tomomi Tsutsumi, Yumiko Oka, Tomoki Takeda, Yuko Shirota, Junichi Kameoka
OP is a histopathological term that refers to the presence of intraluminal buds of loose granulation tissue consisting of fibroblasts embedded in connective tissue [13]; thus, a definitive diagnosis of OP is made histopathologically. However, owing to the invasiveness of biopsy and the accumulation of clinical features of OP, it could be diagnosed on the basis of clinical features consisting of typical CT findings, lack of causative agents, good response to glucocorticoids, and lack of response to antibiotics. It should be strongly noted that OP is often difficult to distinguish from infectious diseases or malignant tumours. Therefore, when attempting treatment with agents other than glucocorticoids, such as tofacitinib in this case, the drugs should be used only in patients with recurrence due to decreased glucocorticoid dose after fully assessing the responsiveness to glucocorticoids. Our cases were clinically diagnosed as described earlier. Therefore, it is not a definite case of histological diagnosis and the possibility of post infectious OP, eosinophilic pneumonia, and malignant tumours could not be completely ruled out. Especially in case 1, since eosinophils in the blood were also slightly elevated, the possibility of drug-induced eosinophilic pneumonia was fully considered, but the course of relapses seems to be too long. Fortunately, the malignant tumour was finally denied, as the shadows disappeared completely.
Bronchoalveolar lavage: role in the evaluation of pulmonary interstitial disease
Published in Expert Review of Respiratory Medicine, 2020
Stanca-Patricia Hogea, Emanuela Tudorache, Camelia Pescaru, Monica Marc, Cristian Oancea
The diagnosis of ELD is usually made through the association of pulmonary infiltrates on imaging and increased eosinophil counts in blood and/or BAL fluid. The diagnostic contribution of BAL in this disease may be particularly helpful if the level of blood eosinophils is normal. In most cases the biopsy is no longer necessary in patients with ELD. The percentage of eosinophils can vary largely, ranging from 20 to 90%, in patients with eosinophilic infiltrates. In clinical practice, an increase in the BAL eosinophil percentage more than 25% is strongly supportive of eosinophilic pneumonia as a diagnosis. The diagnostic value of mild BAL eosinophilia is limited and can be associated with other ILDs than the classic ELD, such as idiopathic pulmonary fibrosis, sarcoidosis, HP, infections, connective tissue diseases, pneumoconiosis, PLCH and radiation pneumonitis, but these conditions rarely include more than 10% eosinophils.
Favorable response to asthma-dosed subcutaneous mepolizumab in eosinophilic pneumonia
Published in Journal of Asthma, 2019
Robert Y. Lin, Toni P. Santiago, Nina M. Patel
In the United States, mepolizumab is currently approved for subcutaneous use in severe asthma [1] and in eosinophilic granulomatosis with polyangiitis [2]. The approved dosing for these conditions is 100 mg and 300 mg, respectively. Two other biologic agents focused on reducing eosinophils in asthma (reslizumab and benralizumab) are currently approved in the United States [3,4]. Other conditions associated with increased tissue quantities of eosinophils have been examined for treatment responses to eosinophil reducing agents. These have included hypereosinophilic syndrome (HES) [5] and eosinophilic esophagitis [6,7] with more beneficial effects noted in the former, albeit rare condition. Utility of biologics in chronic eosinophilic pneumonia (CEP) has not been described in detail despite the known potential for complications of chronic high dose steroid therapy typically required in this disorder, and the persistent lung function impairment often observed [8]. CEP is a rare condition, whose diagnosis is based on chronic respiratory symptoms, eosinophilic involvement of the lung parenchyma, radiologic findings often including ground glass infiltrates on chest computerized tomography, and exclusion of other eosinophilic pulmonary disorders [9]. To our knowledge there has only been a single published report on the efficacy of the asthma approved dose of mepolizumab in CEP [10]. In this report, we describe a patient with biopsy confirmed CEP who responded favorably to asthma-dosed mepolizumab and discuss the implications of these findings.