Eosinophilic Pneumonia - DOC

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					                                  Eosinophilic Pneumonia

    1. Differential Diagnosis of Pulmonary Eosinophilia
           a. Helminthic infections
                   i. Loffler’s syndrome
                         1. Ascaris Lumbricoides
                         2. Strongyloides Stercoralis
                         3. Hookworms
                  ii. Persistent parenchymal invasion
                         1. Paragonimus
                         2. Echinococcocis
                         3. Cysticercosis
           b. Medications
                   i. NSAIDS
                  ii. Antibiotics
                         1. ampicillin, nitrofurantoin, sulfonamides, minocycline
                         2. anticonvulsants, antidepressants, ACE inhibitors, b-
                              blockers, hydrochlorthiazide and other sulfa-containing
                              compounds, radiographic contrast media, L-tryptophan,
                              methotrexate, amiodarone, and bleomycin
           c. Acute and Chronic Eosinophilic Pneumonia
           d. Churgg-Strauss syndrome
           e. Allergic Bronchopulmonary Aspergillosis

    2. Idiopathic eosinophillic pneumonia
           a. Etiology: ? inhaled antigen
           b. Epidemiology: Rare, can affect any age, but usually ages 20-40. M > F.
           c. Signs and sx: Febrile illness for less than 3 weeks, non-productive cough,
              dyspnea, malaise, myalgia, dyspnea, nightsweats, pleuritic chest pain
           d. Hypoxemic respiratory failure can occur in up to 60% of patients
           e. Labs: besides CBC with diff, usually not too helpful. May have initial
              neutrophil predominance on differential
           f. CXR: bilateral diffuse alveolar or reticular infiltrates
           g. Chest CT: Bilateral patchy, ground glass opacities and reticular infiltrate
           h. PFTs: Restrictive pattern
           i. BAL: >25% eosinophils. This should resolve with treatment
           j. Treatment: Prednisone 40-60 mg per day if no respiratory failure;
              methylprednisolone 60-125mg IV q6




References:
                          1.   UptoDate, “Idiopathic acute eosinophilic pneumonia,” “Pulmonary
                               eosinophilia”
                          2.   Philit, F, Etienne-Mastroianni, B, Parrot, A, et al. Idiopathic acute
                               eosinophilic pneumonia: a study of 22 patients. Am J Respir Crit Care
                               Med 2002; 166:1235.

				
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Description: Eosinophilic Pneumonia