Síndrome de eosinofília pulmonar presentación clínica y serie de casos / [Lung eosinophilic syndrome: clinical presentation and cases report].

INTRODUCTION: Pulmonary eosinophilia syndrome is characterized by a group of diseases that present clinical-radiological conditions, pulmonary eosinophilia or peripheral lung parenchyma in its evolution. We described the clinical and radiological presentation. METHODS: Retrospective descriptive analysis of medical records of 7 patients between 2007 and 2010. RESULTS: The highest numbers of cases were observed in women, with peripheral eosinophilia with values between 550 and 10,000 cells/mm3. The more frequent signs and symptoms were cough, dyspnea, fever and wheezing. The more prevalent radiological findings were alveolar interstitial and alveolar pattern. At CT scan, the most frequent pattern was ground glass. The main diagnoses made were acute and chronic eosinophilic pneumonia in equal proportions, both with response to steroids. CONCLUSIONS: The pulmonary eosinophilia syndrome shares common features with clinical and radiological entities most prevalent, particularly community-adquired pneumonia.

Tropical Pulmonary Eosinophilia : Masquerading as Eosinophilic Leukaemia.

Benign conditions like Tropical Pulmonary Eosinophilia(TPE) can present with very high total count and Absolute Eosinophil Count (AEC) and can mimick malignancy. Diagnostic work up for TPE should be done in any patient presenting with pulmonary symptoms and eosinophilia. Though most case series on TPE report AEC in range of 3000 to upto 20,000, very rarely AEC can rise beyond 50,000. The following case is of TPE presenting with absolute eosinophil count of >70,000. Rapid response to Diethyl carbamazine is the rule in a confirmed case of TPE.

Aspirin attenuates the anti-inflammatory effects of theophylline via inhibition of cAMP production in mice with non-eosinophilic asthma

Theophylline is commonly used to treat severe asthma and chronic obstructive pulmonary disease (COPD) characterized by non-eosinophilic inflammation. Acetyl salicylic acid (ASA) is one of the most widely used medications worldwide, but up to 20% of patients with asthma experience aggravated respiratory symptoms after taking ASA. Here we evaluated the adverse effect of ASA on the therapeutic effect of theophylline in mice with non-eosinophilic asthma. A non-eosinophilic asthma mouse model was induced by airway sensitization with lipopolysaccharide-containing allergen and then challenged with allergen alone. Therapeutic intervention was performed during allergen challenge. Theophylline inhibited lung inflammation partly induced by Th1 immune response. ASA attenuated the beneficial effects of theophylline. However, co-administration of the ASA metabolite salicylic acid (SA) showed no attenuating effect on theophylline treatment. The therapeutic effect of theophylline was associated with increase in cAMP levels, which was blocked by co-treatment of theophylline and ASA. ASA co-treatment also attenuated the anti-inflammatory effects of a specific phosphodiesterase 4 inhibitor. These results demonstrate that ASA reverses anti-inflammatory effects of theophylline, and that ASA exerts its adverse effects through the inhibition of cAMP production. Our data suggest that ASA reverses lung inflammation in patients taking theophylline, although clinical evidence will be needed.

Eosinofilia pulmonar / Pulmonary eosinophilia

As formas de eosinofilia pulmonar constituem um grupo heterogêneo definido pela presença de um ou dois critérios: infiltrado pulmonar com eosinofilia sanguínea e/ou eosinofilia tissular caracterizada por eosinófilos demonstrados na biópsia pulmonar ou no lavado broncoalveolar. Embora o infiltrado inflamatório seja composto de macrófagos, linfócitos, neutrófilos e eosinófilos, a presença de eosinofilia é um marcador importante para o diagnóstico e tratamento. A apresentação clínica e radiológica pode revelar eosinofilia pulmonar simples, pneumonia eosinofílica crônica, pneumonia eosinofílica aguda, aspergilose broncopulmonar alérgica e eosinofilia pulmonar associada à doença sistêmica, como na síndrome de Churg-Strauss e na síndrome hipereosinofílica. A asma está frequentemente associada, podendo ser um pré-requisito, como na aspergilose broncopulmonar alérgica e na síndrome de Churg-Strauss. Nas doenças com acometimento sistêmico, a pele, o coração e o sistema nervoso são os órgãos mais comprometidos. A apresentação radiológica pode ser considerada como típica, ou pelo menos sugestiva, para três formas de eosinofilia pulmonar: pneumonia eosinofílica crônica, aspergilose broncopulmonar alérgica e pneumonia eosinofílica aguda. A etiologia da eosinofilia pulmonar pode ser de causa primária (idiopática) ou secundária, compreendendo causas conhecidas, como drogas, parasitas, infecções por fungos e micobactérias, irradiação e toxinas. A eosinofilia pulmonar pode também estar associada a doenças pulmonares difusas, doenças do tecido conectivo e neoplasias.

Pulmonary eosinophilia comprises a heterogeneous group of diseases defined by eosinophilia in pulmonary infiltrates (bronchoalveolar lavage fluid) or in tissue (lung biopsy specimens). Although the inflammatory infiltrate is composed of macrophages, lymphocytes, neutrophils and eosinophils, eosinophilia is an important marker for the diagnosis and treatment. Clinical and radiological presentations can include simple pulmonary eosinophilia, chronic eosinophilic pneumonia, acute eosinophilic pneumonia, allergic bronchopulmonary aspergillosis and pulmonary eosinophilia associated with a systemic disease, such as in Churg-Strauss syndrome and hypereosinophilic syndrome. Asthma is frequently concomitant and can be a prerequisite, as in allergic bronchopulmonary aspergillosis and Churg-Strauss syndrome. In diseases with systemic involvement, the skin, the heart and the nervous system are the most affected organs. The radiological presentation can be typical, or at least suggestive, of one of three types of pulmonary eosinophilia: chronic eosinophilic pneumonia, acute eosinophilic pneumonia and allergic bronchopulmonary aspergillosis. The etiology of pulmonary eosinophilia can be either primary (idiopathic) or secondary, due to known causes, such as drugs, parasites, fungal infection, mycobacterial infection, irradiation and toxins. Pulmonary eosinophilia can be also associated with diffuse lung diseases, connective tissue diseases and neoplasia.

Acute eosinophilic pneumonia due to round worm infestation.

We report a case of an 18 month old child who presented with sever eosinophilic pneumonia requiring ventilation as a result of round worm infestation. This child presented with symptoms alike acute severe asthma and had high absolute eosinophil count of 9,234/cmm.A course of steroids, albendazole and diethylcarbazine were followed by rapid recovery and a decrease in eosinophil counts to 616/cmm within one month of treatment. This is the first reported case of a child with severe eosinophilic pneumonia requiring ventilation as a result of roundworm infection.

Chronic eosinophilic pneumonia: case report and review of literature

Chronic eosinophilic pneumonia [CEP] is a rare disease characterized by dyspnoea and cough with peripheral infiltrate in the chest x-ray and blood eosinophilia. Diagnosis is made clinically and by the presence of eosinophilic infiltrate in lung biopsy and high percentage of eosinophils in broncho alveolar lavage [BAL]. Steriods are the mainstay of therapy for CEP with rapid resolution of symptoms and radiographic findings. When treated, it carries a good prognosis with rare sequelae

Neumonía eosinofílica crónica: a propósito de un caso y revisión de la literatura / Chronic eosinophilic pneumonia in children: a case report and literature review

Introducción: El síndrome de Infiltrados Pulmonares con Eosinofilia (IPE) es poco frecuente en pediatría, constituyendo un grupo heterogéneo de condiciones clínicas, que tienen en común un aumento de los eosinófilos en el lavado broncoalveolar, en el intersticio pulmonar y a nivel periférico, además de presentar síntomas sistémicos. La causa más frecuente del Síndrome IPE es la inducida por parásitos. Otra entidad incluída en este síndrome, la neumonía eosinofílica crónica, puede confundirse con una neumonía comunitaria. Caso clínico: Se presenta a una paciente de 14 años de edad, con un cuadro clínico de dos meses de evolución, caracterizado por tos, disnea, fiebre y baja de peso. La radiografía y la TAC de tórax mostraron infiltrados intersticiales difusos, condensación bilateral de distribución periférica, con mayor compromiso de los lóbulos superiores. El diagnóstico inicial fue de una neumonía adquirida en la comunidad. No hubo respuesta terapéutica al uso de múltiples esquemas de antibióticos, y se demostró eosinofilia a nivel periférico y en el lavado broncoalveolar. La biopsia pulmonar fue compatible con bronquiolitis obliterante con neumonía organizante e infiltrados celulares difusos, especialmente de histiocitos. Los cultivos de sangre, esputo y del lavado broncoalveolar fueron negativos, planteándose el diagnóstico de neumonía eosinofílica crónica. Se suspende la terapia antibiótica y se inició tratamiento con corticoides sistémicos, observándose mejoría clínica en 5 días y radiológica a la segunda semana. Conclusión: Debido a que la neumonía eosinofílica crónica puede tener una evolución fatal, el diagnóstico debe ser hecho precozmente, para iniciar un tratamiento oportuno con corticoides sistémicos, debiendo sospecharse especialmente en niños con presunta neumonía comunitaria, que no responde al tratamiento convencional.

Pneumonia eosinofílica crônica / Chronic eosinophilic pneumonia

Pneumonia eosinofílica crônica é uma entidade clínica rara que se caracteriza por infiltração alveolar e intersticial eosinofílica, de causa desconhecida. Os autores descrevem o caso de uma mulher branca de 49 anos, admitida por dispnéia aos mínimos esforços, de início insidioso e progressivo havia seis meses. Apresentava eosinofilia sérica e no escarro, radiografias de tórax com áreas de infiltração multifocais de distribuição irregular em ambos os pulmões e, na avaliação funcional pulmonar, distúrbio restritivo. O exame histopatológico de tecido pulmonar obtido por biópsia a céu aberto evidenciou pneumonia eosinofílica crônica. Houve marcada melhora clínica, radiológica e funcional após corticoterapia

Acute eosinophilic pneummonia: certain atypical presentations

Patients with Acute eosinophilic pneumonia [AEP] usually present with acute respiratory failure, chest infiltrates with or without pleural effusions and have eosinophilia in the broncho-alveolar lavage fluid. Early institution of steroids is usually rewarded with rapid recovery. Therefore, AEP needs to be distinguished from other common diffuse alveolar disease. Two patients with AEP who had certain atypical manifestation, not described before, are being presented. Pertinent literature has also been reviewed

Pneumonia eosinofílica crônica: relato de um caso / Chronic eosinophilic pneumonia: a case report

Os autores relatam um caso de pneumonia eosinofílica crônica em um paciente de 59 anos de idade, do sexo masculino, com febre e tosse seca há 15 dias. Na história pregressa havia tabagismo e asma de início há 12 anos. A radiografia do tórax mostrou opacidades homogêneas periféricas nos terços superiores. A tomografia computadorizada do tórax demonstrava consolidaçöes periféricas com broncogramas aéreos na periferia dos lobos superiores dos pulmöes. O paciente foi submetido a biópsia "a céu aberto", com diagnóstico histológico de processo intersticial difuso com predomínio de eosinófilos. O paciente foi tratado com corticosteróides, observando-se normalizaçäo dos exames radiológicos após 20 dias

Neumonía de resolución lenta: presentación de caso clínico y revisión de literatura / Slowly revolving pneumonia: clinical case and review

La neumonía de resolución lenta es una entidad poco conocida que ocurre en aproximadamente un 10 por ciento de las pacientes que ingresan con el diagnóstico de neumonía adquirida en la comunidad. Para discutir esta situación clínica se presenta un caso clínico de un cuadro febril asociado a infiltrado radiológicos pulmonares, que no respondió al tratamiento antibiótico y cuya biopsia reveló una neumonía eosinófila crónica. Frente a un caso de neumonía de lenta resolución, es importante establecer si la evolución clínica es sólo atribuible a una resolución clínica lenta condicionado por su edad, comorbilidad, severidad y germen involucrado o se trata realmente de una progresión de la enfermedad para lo cual deben considerarse microoganismo inhabituales, inmunosupresión u otras causas no infecciosas que expliquen el cuadro clínico como lo es el presente caso

Pulmonary involvement in idiopathic hypereosinophilic syndrome.

A case of idiopathic hypereosinophilic syndrome (HES) is presented. The patient had been symptomatic and had documented peripheral blood eosinophilia for 9 years. The patients having only pulmonary involvement, seem to have a good prognosis and hence must be considered as a separate subgroup of HES.

Angeitis alérgica granulomatosa

Presentamos el caso de una mujer de 38 años con asma, eosinofilia periférica, sinusitis y opacidades interticiales difusas, bilaterales y fugaces en la radiografía de tórax. El procedimiento diagnóstico fue biopsia pulmonar a cielo abierto donde se encontró una vasculitis eosinofilica características del Síndrome de Churg-Strauss. Comentamos los principales hallazgos clínicos, radiológicos e histopatológicos.

Atypical radiological presentation of tropical pulmonary eosinophilia.

Two cases of tropical pulmonary eosinophilia presenting with rare unusual radiological appearances of consolidation with associated pleural effusion in one and lobar consolidation in another, are being reported. Both patients showed dramatic improvement to diethylcarbamazine therapy.

Effect of treatment on maximal expiratory flow rates in tropical eosinophilia.

Maximal expiratory flow rates such as peak expiratory flow rate (PEFR), rates at 25%, 50% and 75% of vital capacity (VE max 25%, VE max 50%, VE max 75%) and forced expiratory flow during the middle half of forced vital capacity (FEF 25-75%) were recorded in 23 patients with tropical eosinophilia (TE) before and after treatment. The mean values of all flow rates were significantly lower (P < 0.001) in untreated TE patients compared to predicted values. After three weeks' treatment with diethylcarbamazine, although there was a significant rise in the mean values of all expiratory flow rates (P < 0.05) except VE max 75% (P > 0.2), all flow rates continued to be significantly lower (P < 0.01) at one month than predicted values.

Presentación de un caso de neumonía eosinofílica crónica (NEC) / Cronic eosinophil pneumonia: presentation of case

Se presenta un caso de una paciente de 49 años de edad, sexo femenino, con diagnóstico de neumonía eosinifílica crónica asociada con asma. Se describen las características clínicas, radiológicas y de laboratorio. Presenta antecedentes familiares alérgicos, una historia aprevia de rinitis perenne y asma bronquial de larga evolución. El diagnóstico de este paciente se realizó teniendo en cuenta: 1) el cuadro clínico; 2) la hipereosinofilia periférica, y 3) el infiltrado pulmonar característico. Además se consideró la respuesta espectacular al tratamiento corticoideo, con desaparición de los síntomas clínicos y radiológicos con cinco días de tratamiento