Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Smoking-induced acute eosinophilic pneumonia (AEP)
- Radiologic Findings
- Chest PA shows diffuse bilateral alveolar and reticular opacities. Lung window setting of the chest CT scan shows multifocal ill-defined ground-glass opacities, interlobularseptal thickening and peribronchovascular interstitial thickening in both lungs. Note the bilateral pleural effusions. Bronchoalveolar lavage (BAL) showed eosinophilia.
- Brief Review
- Acute eosinophilic pneumonia (AEP) is characterized by an acute febrile onset, progressive respiratory failure, bilateral chest infiltrates, an increase of eosinophils in bronchoalveolar lavage fluid (>25%), and a dramatic response to
corticosteroids. It was first described by Allen and colleagues in 1989, but the exact cause still remains unknown.
Smoking of cigarettes has been proposed as a cause of AEP, with most cases involving young adults who had recently started smoking.
Chest radiograph shows bilateral pulmonary infiltrates, mixed alveolar and reticular opacities, including ground glass opacities. CT chest shows ground-glass opacities, consolidation, nodular opacities and pleural effusion.
- References
- 1. Bok GH, Kim YK, Lee YM, Kim KU, U ST, Hwang JH, Kim DW. Cigarette smoking-induced acute eosinophilic pneumonia: a case report including a provocation test. J Korean Med Sci 2008;23:134-137.
2. Uchiyama H, Suda T, Nakamura Y, Shirai M, Gemma H, Shirai T, Toyoshima M, Imokawa S, Yasuda K, Ida M, Nakano Y, Inui N, Sato J, Hayakawa H, Chida K. Alterations in smoking habits are associated with acute eosinophilic pneumonia, Chest 2008; 133 :1174-1180.
3. Allen JN, Pacht ER, Gadek JE, Davis WB. Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure. N Engl J Med 1989; 321: 569-574.
4. Watanabe K, Fujimura M, Kasahara K Yasui M, Myou S, Kita T, Watanabe A, Nakao S. Acute eosinophilic pneumonia following cigarette smoking: a case report including cigarette-smoking challenge test. Intern Med 2002; 41: 1016-1020.
5. Shintani H, Fujimura M, Ishiura Y, Noto M. A case of cigarette smoking-induced acute eosinophilic pneumonia showing tolerance. Chest 2000; 117: 277-279.
6. Nakajima M, Manabe T, Niki Y, Matsushima T. Cigarette smoke- induced acute eosinophilic pneumonia. Radiology 1998; 207: 829-831.
- Please refer to
- Case 929 Case 782 Case 698 Case 652 Case 629 Case 601 Case 596 Case 480 Case 260 Case 200 Case 128 Case 105
-
- Keywords
- Acute Eosinophilic Pneumonia, Lung, Eosinophilic lung disease,