Other interstitial pneumonitis / fibrosis

Chronic eosinophilic pneumonia

Topic Completed: 1 September 2011

Minor changes: 11 August 2020

Copyright: 2003-2021,, Inc.

PubMed search: chronic eosinophilic pneumonia [title]

Elliot Weisenberg, M.D.
Page views in 2020: 1,005
Page views in 2021 to date: 1,010
Cite this page: Weisenberg E. Chronic eosinophilic pneumonia. website. Accessed October 23rd, 2021.
Definition / general
  • Reaction to drugs, Aspergillus or other fungi, occurs with some malignancies and connective tissue diseases
  • Prolonged (months) febrile illness with cough, weight loss, generalized fatigue, drenching night sweats and peripheral eosinophilia
  • Associated with chronic asthma, usually in setting of allergic bronchopulmonary aspergillosis
  • Xray: patchy infiltrates in peripheral lungs with central sparing
  • Steroids cause complete resolution
Gross description
  • Consolidation, mucus plugs in distal bronchi or bronchioles
Microscopic (histologic) description
  • Patchy intraalveolar edema, interstitial inflammation with giant cells and eosinophils with scattered histiocytes and plasma cells
  • Mucus plugs composed of inflammatory cells and cellular debris
  • Charcot-Leyden crystals may be present
  • Often bronchiolitis obliterans
  • Blood vessel infiltration by inflammatory cells is common, but no vascular necrosis
  • No diffuse alveolar damage
Differential diagnosis
  • DIP (if extensive intra-alveolar macrophages)
  • Langerhans cell histiocytosis (interstitial infiltrate, Langerhans cells)
  • Extrinsic allergic alveolitis (less edema, more interstitial inflammation)
  • Parasites
  • Fungal allergies
  • Other causes of pulmonary eosinophilia must be excluded
Additional references
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