Other interstitial pneumonitis / fibrosis
Idiopathic eosinophilic pneumonia
Reviewers: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 23 September 2011, last major update September 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.
● Diagnosis of exclusion
● Lung disease associated with eosinophils in alveolar and interstitial spaces, usually with peripheral eosinophilia, but excluding Langerhans cell histiocytosis
● Must exclude drug reactions (antibiotics, cytotoxic or anti-inflammatory drugs), immune disorders (Churg-Strauss syndrome, collagen vascular disease, asthma, hypereosinophilic syndrome, chronic eosinophilic leukemia NOS, myeloid and lymphoid neoplasms with eosinophilia and rheumatoid arthritis), infections (bacteria, Aspergillus, HIV, parasites-helminths, Dirofiliaria and filarial) or tobacco (flavored cigars, Chest 2007;131:1234, new onset of smoking, JAMA 2004;292:2997)
● Symptoms: fever, weight loss and shortness of breath
● Xray: peripheral infiltrate
● Classified as simple, acute or chronic
● Simple eosinophilic pneumonia: see Loeffler’s syndrome
● Acute eosinophilic pneumonia: onset in 1-4 days, accompanied by fever, cough, dyspnea and chest pain; unknown cause, prominent eosinophils in bronchoalveolar lavage fluid (Am J Respir Crit Care Med 2002;166:1235) and diffuse alveolar damage at biopsy
● Chronic eosinophilic pneumonia
● 6 year old boy post-chemotherapy for neuroblastoma with bilateral pulmonary infiltrates (Case of the Week #105)
● Steroids cause dramatic response to acute or chronic forms
● Acute form has diffuse alveolar damage
● Alveolar and interstitial infiltration by eosinophils, also plasma cells and histiocytes
● May have Charcot-Leyden crystals
● Variable angiitis, granulomatosis, fibrosis, mucus plugging and bronchiolitis with necrosis
Acute eosinophilic pneumonia
End of Lung-nontumor > Other interstitial pneumonitis / fibrosis > Idiopathic eosinophilic pneumonia
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