ABSTRACT
RATIONALE: Eosinophilic pulmonary disease (EPD) is a general term for a large group of diseases with complex etiology. Ulcerative colitis is an inflammatory bowel disease (IBD). Patients with IBD may have pulmonary involvement. We herein present a case of ulcerative colitis complicated with EPD. PATIENT CONCERNS: A 34-year-old woman with ulcerative colitis presented with dry cough. She had peripheral eosinophilia and apical ground glass opacities on CT (computed tomography) of her chest. Antibiotic treatment was ineffective. DIAGNOSES: Lung biopsy revealed eosinophil infiltration in the alveolar space and interstitial space, so EPD was considered. INTERVENTIONS: After oral administration of prednisone, the lung shadow on CT disappeared when the cough symptoms resolved. However, the symptoms recurred after drug withdrawal, and the lung shadow reappeared on imaging. The cough symptoms and lung shadow disappeared after oral prednisone was given again. Prednisone was slowly discontinued after 6 months of treatment. OUTCOMES: The patient stopped prednisone for half a year. No recurrence or abnormal CT findings were detected during the half-year follow-up. LESSONS: The clinical manifestations of EPD are atypical, laboratory and imaging findings are not specific, and it is difficult to make a definite diagnosis before lung biopsy. The diagnosis depends on pathological examination. Glucocorticoid treatment is effective, but some patients may relapse after drug withdrawal. Active follow-up after glucocorticoid treatment is very important for identifying disease recurrence. Patients with IBD are relatively prone to developing EPD. The etiology of EPD is complex. In clinical practice, we need to make a diagnosis and differential diagnosis to clarify its etiology.
Subject(s)
Colitis, Ulcerative , Prednisone , Pulmonary Eosinophilia , Humans , Female , Adult , Colitis, Ulcerative/complications , Colitis, Ulcerative/diagnosis , Colitis, Ulcerative/drug therapy , Pulmonary Eosinophilia/diagnosis , Pulmonary Eosinophilia/drug therapy , Pulmonary Eosinophilia/etiology , Prednisone/therapeutic use , Prednisone/administration & dosage , Tomography, X-Ray Computed , Glucocorticoids/therapeutic use , Glucocorticoids/administration & dosage , Diagnosis, DifferentialABSTRACT
The nexus between eosinophils and microbes is attracting increasing attention. We previously showed that airway administration of sterile microbial products contained in dust collected from traditional dairy farms virtually abrogated bronchoalveolar lavage (BAL) eosinophilia and other cardinal asthma phenotypes in allergen-sensitized specific pathogen-free (SPF) mice. Interestingly, comparable inhibition of allergen-induced BAL eosinophilia and promotion of airway barrier integrity were found upon administration of a sterile, pharmacological-grade bacterial lysate, OM-85, to the airway compartment of allergen-sensitized SPF mice. Here, we asked whether intrinsic properties of airway-delivered microbial products were sufficient to inhibit allergic lung inflammation or whether these effects were mediated by reprogramming of the host microbiota. We compared germ-free (GF) mice and offspring of GF mice associated with healthy mouse gut microbiota and maintained under SPF conditions for multiple generations (Ex-GF mice). These mice were treated intranasally with OM-85 and evaluated in the ovalbumin and Alternaria models of allergic asthma focusing primarily on BAL eosinophilia. Levels of allergen-induced BAL eosinophilia were comparable in GF and conventionalized Ex-GF mice. Airway administration of the OM-85 bacterial lysate was sufficient to inhibit allergen-induced lung eosinophilia in both Ex-GF and GF mice, suggesting that host microbiota are not required for the protective effects of bacterial products in these models and local airway exposure to microbial products is an effective source of protection. OM-85-dependent inhibition of BAL eosinophilia in GF mice was accompanied by suppression of lung type 2 cytokines and eosinophil-attracting chemokines, suggesting that OM-85 may work at least by decreasing eosinophil lung recruitment.
Subject(s)
Allergens , Germ-Free Life , Animals , Mice , Allergens/immunology , Asthma/immunology , Pulmonary Eosinophilia/immunology , Pulmonary Eosinophilia/etiology , Pulmonary Eosinophilia/pathology , Ovalbumin/immunology , Female , Bronchoalveolar Lavage Fluid/immunology , Lung/pathology , Lung/immunology , Lung/microbiology , Mice, Inbred BALB C , Cell Extracts/pharmacology , Disease Models, Animal , Bacterial LysatesABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Pulmonary Eosinophilia/etiology , Coronavirus Infections/complications , Pulmonary Eosinophilia/pathology , Biopsy , Severe acute respiratory syndrome-related coronavirus/isolation & purification , Polymerase Chain Reaction , Pneumonia, Viral/complications , Acute DiseaseABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Angiolymphoid Hyperplasia with Eosinophilia/diagnostic imaging , Pulmonary Eosinophilia/diagnostic imaging , Pulmonary Eosinophilia/etiology , Angiolymphoid Hyperplasia with Eosinophilia/pathology , Immunohistochemistry , Diagnosis, DifferentialABSTRACT
The terms 'eosinophilic pneumonia' and 'eosinophilic lung disease' loosely describe a heterogeneous group of pulmonary diseases of varying aetiologies and severity. The diseases are characterised by infiltration of lung parenchyma by eosinophils; peripheral eosinophilia is not required for diagnosis. In this article; major clinical entities are appraised with respect to clinical; pathological and radiological features. Diseases without pulmonary infiltration or radiographic abnormalities; such as allergic asthma; are not included in this review
Subject(s)
Lung Diseases , Pulmonary Eosinophilia , Pulmonary Eosinophilia/etiology , ReviewABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Styrenes/adverse effects , Bronchitis/immunology , Pulmonary Eosinophilia/etiology , Occupational Diseases , Occupational Exposure , Respiratory Hypersensitivity/diagnosisABSTRACT
Los síndromes de infiltrados pulmonares con eosinofilia (síndromes PIE) constituyen un grupo heterogéneo de desórdenes poco frecuentes, de diferente etiopatogenia y presentación clínica variable. Estos cuadros tienen en común la presencia de infiltrados pulmonares y eosinofilia periférica, en el lavado broncoalveolar y en el intersticio pulmonar; aunque además pueden existir síntomas sistémicos. Actualmente se recomienda clasificar a los síndromes PIE según la etiología en idiopáticos y secundarios. Dentro de los primeros se encuentran la eosinofilia pulmonar simple (síndrome de Loeffler), neumonía eosinofílica aguda, neumonía eosinofílica crónica, síndrome hipereosinofílico idiopático, granulomatosis alérgica o síndrome de Churg- Strauss y granulomatosis broncocéntrica. Los secundarios incluyen la aspergilosis broncopulmonar alérgica, eosinofilia inducida por parásitos (forma más frecuente en pediatría) y por drogas. Los corticoides constituyen el tratamiento de elección, en cambio cuando la etiología son parásitos la terapia debe ser hecha con fármacos antiparasitarios. Se debe tener un alto índice de sospecha en el diagnóstico, debido a la escasa frecuencia que presentan estos síndromes y a la significativa morbilidad y en ocasiones mortalidad, especialmente la neumonía eosinofílica aguda, que se manifiesta frecuentemente con insuficiencia respiratoria severa de etiología desconocida.
Subject(s)
Humans , Child , Pulmonary Eosinophilia/diagnosis , Pulmonary Eosinophilia/therapy , Acute Disease , Algorithms , Bronchoalveolar Lavage , Chronic Disease , Adrenal Cortex Hormones/therapeutic use , Pulmonary Eosinophilia/classification , Pulmonary Eosinophilia/etiology , Parasites/pathogenicity , Pharmaceutical Preparations/adverse effects , SyndromeABSTRACT
The mechanism and cause of acute eosinophilic pneumonia are largely unknown. Many factors including the smoking of cigarettes have been suggested, but none have been proven to directly cause acute eosinophilic pneumonia. The authors report a case of acute eosinophilic pneumonia in a young Asian male who recently started smoking. The diagnosis was made based on his clinical course and results of chest radiography, lung spirometry, bronchoalveolar lavage, and transbronchial lung biopsies. After administration of methylprednisolone, his clinical course rapidly improved. A provocation test was designed to establish a connection between cigarette smoking and the development of acute eosinophilic pneumonia. After the provocation test, the patient showed identical symptoms, increase in sputum eosinophils, and worsening of pulmonary function. The results of the provocation test suggest that smoking may directly cause acute eosinophilic pneumonia, and support previous reports of cigarette smoking-induced acute eosinophilic pneumonia.
Subject(s)
Adolescent , Humans , Male , Acute Disease , Bronchial Provocation Tests , Pulmonary Eosinophilia/etiology , Smoking/adverse effectsABSTRACT
In 1932, Loffler described a syndrome of self-limiting, transient pulmonary infiltrates associated with peripheral blood eosinophilia and mild pulmonary symptoms. A number of conditions are related to pulmonary eosinophilia or pulmonary infiltration with eosinophilia. Especially, parasitic infestations are often related to pulmonary eosinophilia, but only two cases associated with Clonorchis sinensis have been anecdotally reported in English literature. Here we report a case of migrating pulmonary eosniophilic infiltrations associated with Clonorchis sinensis that was successfully treated with praziquantel. Clonorchiasis should be considered in patients with marked eosinophilia and pulmonary infiltrations.
Subject(s)
Animals , Humans , Male , Middle Aged , Biopsy , Clonorchiasis/complications , Clonorchis sinensis/isolation & purification , Pulmonary Eosinophilia/etiology , SyndromeABSTRACT
Drugs are well known causes of eosinophilic lung disease. In many patients, drug-induced eosinophilic lung disease presents with transient eosinophilic infiltrates that disappear after discontinuation of the drug. Some patients, however, experience a fulminant, acute eosinophilia-like disease. Recently, we experienced a case of amitriptyline-associated acute eosinophilic pneumonia with respiratory failure in a diabetic hemodialysis patient. Eight days after treatment with amitriptyline, sudden fever, chill, dry cough and dyspnea developed. Subsequently, multiple patch consolidations appeared on the chest radiographs. Bronchoalveolar lavage (BAL), established a diagnosis of acute eosinophilic pneumonia. After immediate discontinuation of amitriptyline, a rapid clinical and radiological improvement was observed. The present case indicates that the possibility of acute eosinophilic pneumonia should be fully considered in dialysis patients developing unexplained respiratory symptoms while on amitriptyline therapy.
Subject(s)
Adult , Female , Humans , Acute Disease , Amitriptyline/adverse effects , Antidepressive Agents, Tricyclic/adverse effects , Pulmonary Eosinophilia/etiology , Renal DialysisABSTRACT
Infection with Wuchereria bancrofti, Brugia malayi, or B. timori not only affects the structure and function of lymphatic vessels but is also associated with extralymphatic pathology and disease. Because it is now possible to detect living adult worms by ultrasonography, much emphasis is placed on lymphatic pathology. However, the finding of renal damage in asymptomatic microfilaremic carriers has led to increased recognition of the importance of extralymphatic clinical manifestation in bancroftian filariasis. The authors present a number of clinical syndromes that may be manifestations of extralymphatic filarial disease and discuss possible mechanisms that cause these conditions. The main purpose of this paper is to raise the awareness of students and physicians of the prevalence and the importance of extralymphatic disease in bancroftian filariasis so that it is diagnosed and treated properly and also to alert for the need of additional research in this area.
Subject(s)
Humans , Arthritis/etiology , Exanthema/etiology , Filariasis/complications , Granuloma/etiology , Kidney Diseases/etiology , Pulmonary Eosinophilia/etiology , Splenomegaly/etiologyABSTRACT
La Enfermedad Pulmonar Eosinófila es producida por diferentes patologías, en las cuales hay un aumento de los eosinófilos tisulares y circulantes. Los mecanismos patogénicos, en la mayoría de las causas están pobremente aclarados. Entre los desórdenes que pueden desencadenarla se encuentran hipersensibilidad a drogas; secundaria a enfermedad parasitaria; micosis; vasculitis y otras enfermedades infecciosas como la tuberculosis. También puede acompañar a neoplasias como carcinoma broncogénico y enfermedad de Hodgkin. Se presenta el caso de un paciente de sexo masculino, de 45 años de edad con SIDA y Tuberculosis Pulmonar, que durante el tratamiento desarrolla eosinofilia periférica e infiltrados fugases (periféricos y bilaterales) en la radiografía de tórax. Se concluye que los pacientes con Sida y Tuberculosis, tienen mayor proporción de reacciones adversas a drogas, y que la Tuberculosis puede desencadenar per se una Eosinofilia Pulmonar Simple o Idiopática.
Subject(s)
Humans , Male , Middle Aged , Pulmonary Eosinophilia/etiology , Pulmonary Eosinophilia/physiopathology , Acquired Immunodeficiency Syndrome/complications , Tuberculosis, Pulmonary/complications , Carcinoma, Bronchogenic/complications , Drug Hypersensitivity , Hodgkin Disease/complications , Mycoses , Rifampin/adverse effects , Sulfasalazine/adverse effectsABSTRACT
La Enfermedad Pulmonar Eosinófila es producida por diferentes patologías, en las cuales hay un aumento de los eosinófilos tisulares y circulantes. Los mecanismos patogénicos, en la mayoría de las causas están pobremente aclarados. Entre los desórdenes que pueden desencadenarla se encuentran hipersensibilidad a drogas; secundaria a enfermedad parasitaria; micosis; vasculitis y otras enfermedades infecciosas como la tuberculosis. También puede acompañar a neoplasias como carcinoma broncogénico y enfermedad de Hodgkin. Se presenta el caso de un paciente de sexo masculino, de 45 años de edad con SIDA y Tuberculosis Pulmonar, que durante el tratamiento desarrolla eosinofilia periférica e infiltrados fugases (periféricos y bilaterales) en la radiografía de tórax. Se concluye que los pacientes con Sida y Tuberculosis, tienen mayor proporción de reacciones adversas a drogas, y que la Tuberculosis puede desencadenar per se una Eosinofilia Pulmonar Simple o Idiopática. (AU)
Subject(s)
Humans , Male , Middle Aged , Acquired Immunodeficiency Syndrome/complications , Pulmonary Eosinophilia/etiology , Pulmonary Eosinophilia/physiopathology , Tuberculosis, Pulmonary/complications , Drug Hypersensitivity , Mycoses , Sulfasalazine/adverse effects , Rifampin/adverse effects , Carcinoma, Bronchogenic/complications , Hodgkin Disease/complicationsABSTRACT
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.
Subject(s)
Humans , Female , Adult , Churg-Strauss Syndrome/surgery , Churg-Strauss Syndrome/classification , Churg-Strauss Syndrome/complications , Churg-Strauss Syndrome/diagnosis , Churg-Strauss Syndrome/epidemiology , Churg-Strauss Syndrome/etiology , Churg-Strauss Syndrome/physiopathology , Churg-Strauss Syndrome/mortality , Churg-Strauss Syndrome/pathology , Churg-Strauss Syndrome/drug therapy , Churg-Strauss Syndrome , Churg-Strauss Syndrome/therapy , Pulmonary Eosinophilia/complications , Pulmonary Eosinophilia/diagnosis , Pulmonary Eosinophilia/drug therapy , Pulmonary Eosinophilia/epidemiology , Pulmonary Eosinophilia/etiology , Pulmonary Eosinophilia/physiopathology , Pulmonary Eosinophilia/surgery , Pulmonary Eosinophilia/therapyABSTRACT
A presente revisäo bibliográfica tem como objetivo alertar os profissionais da área de saúde para as hipereosinofilias transitórias e auto-resolutivas na regiäo do Grande Recife-Brasil, área endêmica de filariose bancroftiana. Os autores fazem consideraçSes gerais (aspectos imunológicos, etiológicos e patológicos) sobre a Síndrome de Loffler (SL), que é largamente distribuída nas áreas tropicais, sub-tropicais e em climas temperados. Ressaltam a importância es síndrome e a eosinofilia pulmonar tropical like (EPT-like), onde os agentes etiológicos seriam o áscaris, stroongyloides e, possívelmente, os Ancilostomídeos. Tanto a EPT como a EPT-like säo de longa duraçäo, podendo cursar em alguns pacientes con níveis de eosinófilos semelhantes a SL, porém, geralmente säo mais elevados. No tocante às diversas formas clínicas de filariose, os autores descartam: (a) relaçäo direta de hipereosinofilia com a presença do verme microfilária e/ou verme adulto, exceçäo de EPT e (b) a validade do teste de imunofluorescência indireta para o diagnóstico da filariose doença ou infecçäo, ainda largamente utilizada na nossa regiäo