대한흉부영상의학회 Weekly Chest Cases

Case No : 1446 Date 2025-07-07

Courtesy of Hyungin Park / Haeundae Paik Hospital
Age/Sex 74 / F
Chief ComplaintFever, Skin rash

Figure 1
Figure 2
Figure 3

Diagnosis With Brief Discussion

Diagnosis: Drug-induced pulmonary eosinophilia
Radiologic Findings: Fig 1. Chest PA shows multifocal patchy nonsegmental consolidations in both lungs.
Fig 2. Thin-section axial CT scans show multifocal patchy consolidations and poorly defined nodules in subpleural region.
Fig 3. Two weeks later, CT shows improved consolidation with residual pulmonary fibrosis in corresponding areas
Brief Review: The patient’s peripheral eosinophilic blood count was 19%. The patient had been taking antifungal medication prior to the onset of the skin rash. After two weeks after discontinuation of the antifungal medication, the symptoms improved along with radiologic findings
Pulmonary eosinophilia is defined as the infiltration of eosinophils into the lung compartments constituting airways, interstitium, and alveoli. Various infections, drugs, parasites, autoimmune processes, malignancies, and obstructive lung diseases have been associated with increased eosinophils in the lungs.
Pulmonary eosinophilia is characterized by the prominent infiltration of the lung parenchyma by eosinophils, along with other inflammatory cells such as lymphocytes, plasma cells, and polymorphonuclear neutrophils. .
The diagnosis of drug-induced eosinophilic pneumonia is based on exposure to a drug without any obvious other cause of eosinophilic pneumonia, and with the removal of that drug, eosinophilic pneumonia improves.
Bronchoscopy with BAL is a common diagnostic tool that identifies the pulmonary eosinophilia with BAL fluid eosinophil greater than 25%. Normally, eosinophils constitute less than 2% of the BAL cell count. Peripheral eosinophilia occurs when eosinophil blood count is greater than 0.5 × 10/L (500/microliters). 
References: 1. Bernheim A, McLoud T. A Review of Clinical and Imaging Findings in Eosinophilic Lung Diseases. AJR Am J Roentgenol. 2017 May;208(5):1002-1010.
2. Bush A. Pathophysiological Mechanisms of Asthma. Front Pediatr. 2019;7:68.
3. Crowe M, Robinson D, Sagar M, Chen L, Ghamande S. Chronic eosinophilic pneumonia: clinical perspectives. Ther Clin Risk Manag. 2019;15:397-403.
4. Taweesedt P.T., Nordstrom C.W., Stoeckel J., Dumic I. Pulmonary manifestations of 4. drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: a systematic review. Biomed Res Int. 2019;2019:7863815. 
Keywords

No. of Applicants : 71

▶ Correct Answer : 3/71, 4.2%

- Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
- Kyeongpook National University Hospital , Korea (South) JUNGMIN LEE
- Chonbuk National University Hospital , Korea (South) SUBIN LEE

▶ Correct Answer as Differential Diagnosis : 2/71, 2.8%

- , Japan SHUNJIRO NOGUCHI
- Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO

▶ Semi-Correct Answer : 19/71, 26.8%

- medical scanning , Japan HIROAKI ARAKAWA
- Kyoto University , Japan AKIHIKO SAKATA
- Affilitated Hospital of Jining Medical college , China JIANG SHENG HUA
- McGill University Health Center , Canada ALEXANDRE SEMIONOV
- Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
- , Korea (South) JIN YOUNG LEE
- , China FANG YING GEN
- Seoul Medical Center , Korea (South) HYUK GI HONG
- Osaka University , Japan AKINORI HATA
- University of Yamanashi , Japan HIROYUKI MORISAKA
- Yonsei University,Severance Hospital , Korea (South) JUN GU KANG
- , Japan MASAMICHI IWAI
- Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
- Chonnam National University Hospital , Korea (South) HYUNG-JOO OH
- Mie university , Japan SHIKO OKABE
- Kyoto University , Japan SHO KOYASU
- Kobe Children , Japan SHUHEI NORIMOTO
- Fukuoka university , Japan KEISUKE SATO
- The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1446 Date 2025-07-07

Discussion

No. of Applicants : 71