Chronic eosinophilic pneumonia

Case contributed by Henry Knipe

Presentation

Shortness of breath for the last 2-3 months, fever, and cough. No hemoptysis.

Patient Data

Age: 40 years
Gender: Male
x_ray

Multiple regions of airspace opacification are present throughout both lungs, most severe in the left upper lobe. No pleural effusion. Normal cardiomediastinal contour. No bone lesion. 

Peripheral areas of airspace consolidation throughout both lungs with a predominance for the middle and upper lobes. 

Full blood examination demonstrated an eosinophilia 20x the upper limits of normal. Parasitic and fungal screens were negative. No recent antibiotic use. The patient proceeded to bronchoscopy: 

Specimen Type: Broncho-alveolar Lavage 

MACROSCOPIC DESCRIPTION: 10ml cloudy colourless fluid.

MICROSCOPIC DESCRIPTION: The smears contain scattered alveolar macrophages in a background of abundant eosinophils. No fungal elements demonstrated on Grocott stain. No features present to suggest alveolar proteinosis. No malignant cells are identified.

DIFFERENTIAL CELL COUNT

  • Alveolar macrophages 27% (83-94%)
  • Lymphocytes 02% (5-16%)
  • Neutrophils 0% (1-6%)
  • Eosinophils 71% (0-1%)
  • Bronchial cells 0% (0-5%)

DIAGNOSIS: Broncho-alveolar Lavage: Marked eosinophilia. Negative for malignancy.

Case Discussion

The patient commenced on steroids with clinical and radiographic improvement. Chronic eosinophilic pneumonia is one of the eosinophilic lung diseases, and differs from acute eosinophilic pneumonia predominantly by length of symptoms. 

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