Acute eosinophilic pneumonia
Upcoming SlideShare
Loading in...5

Like this? Share it with your network

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads


Total Views
On Slideshare
From Embeds
Number of Embeds



Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

    No notes for slide


  • 1. Eosinophilic PneumoniaAbdalmohsen AbabtainSenior ResidentSaudi Board for Emergency MedicineMarch 31st 2013Supervised by :Dr Ghassan Alghamdi
  • 2. Case 19 Years old Presented to ER with SOB and Sore throat and fever for 2 Days after coming Back from Makkah Has a Hx of atopy (SOB from Dust) with positive Family history too He Started to smoke cigarettes a week ago (a cigarette/day)
  • 3. Exam T 36.8 P:122 BP 120/65 RR 30 SpO2 79% RA Patient looks in Respiratory Distress In Tripod Position Equal Bilatral Airentry No Wheeze, No Stridor nor drooling
  • 4. Labs WBC 25.6 (mostly Nuetrophilic) Lactate 12.3 Urine Tox Negative BG : PH 7.27 Co2 30 Po2 85 Hco3 14
  • 5. In ER Asthma Management Started In ER Patient continue to Deteriorate Tubed ! HIGH Peak and Airway Pressure !
  • 6. In ICU H1N1 & Influenza & Parainfluenza and AFB Negative Lactate started to Normalized BAL Done and ShowedEos 14% Acute Eosinophilic Pneumonia !!!
  • 7. What’s the Fastest Legal StreetCar on Earth ?
  • 8. Bugatti Veyron Super Sport Max Speed 430km/hr 0-100 km in 2.4 Seconds !! 1200 hp !! Base Price $2,400,000
  • 9. Eosinophilic Lung Diseases Group of Disorders with high eosinophils in Lung Parenchyma The Defining Characteristics include either:1. Peripheral Blood Eosinophilia with Radiological Pulmonary Abnormality2. Lung tissue eosinophilia in Biopsy3. High eosinophils in BAL
  • 10. Eosinophilic Lung Diseases Acute Eosinophilic Pneumonia (AEP) Chronic Eosinophilic Pneumonia (CEP) Helminthic Infections (Löfflers syndrome) Non-Helminthic Infection (Coccidioidal infection) Medications (NSAID) Toxins Churg-Strauss Syndrome Allergic Bronchopulmonary Aspergellousis (ABPA)
  • 11. Toxins Scorpion stings Inhalation of heroin or crack cocaine Inhalation of organic chemicals during rubber manufacture Inhalation of dust or smoke Abuse of 1,1,1-trichloroethane (Scotchguard)
  • 12. Acute eosinophilic pneumonia Acute febrile illness with  Severe hypoxaemia,  Diffuse pulmonary infiltrates  Increase in bronchoalveolar lavage (BAL) eosinophils  No evidence of infection or Drug ingesion
  • 13.  Less than 100 cases of AEP have been reported to date The largest series including only 33 patients An epidemiologic study of this disease identified 18 patients with AEP among183,000 US military personnel deployed in Iraq, all of them were smokers, with 78% of them recently beginning to smoke Chest 2008; 133: 1174–1180 JAMA 2004; 292:2997–3005
  • 14. Inhalational exposuresassociated with AEP Smoke (Most common specially first time) Passive smoking* !! World Trade Center demolition dust Firework Tear gas bomb explosion Gasoline tank cleaning Cave exploration Woodpile moving Chest 2000;117:277–279 *Allergology International. 2010;59:421-423
  • 15. ApproachHistory :  Chief complain and Associated symptoms  Medication  Chemical and occupational Exposure (NSAID, Dust, Smoke)  Travel Hx (Fungal inf.)  Respiratory Hx (Asthma)  Extrapulmonary Involvment
  • 16. Physical Exam Fever Tachypnea Bibasilar inspiratory crackles or could be clear in 20% of Patients Hypoxemic respiratory insufficiency is frequently identified at presentation and often requires mechanical ventilation Semin Respir Crit Care Med. 2006 Apr;27(2):142-7.
  • 17. Labs Patients generally present with an initial neutrophilic leukocytosis Blood eosinophilia, However, the absence of it does not exclude these conditions. Any concomitant glucocorticoid therapy will suppress blood eosinophilia The magnitude of blood eosinophilia is not a reliable means to distinguish the possible etiologies of pulmonary eosinophilia. High ESR !
  • 18. Imaging At the Start, Subtle reticular or ground glass opacities, often with Kerley B lines Small pleural effusions are common
  • 19. Imaging High resolution CT ground-glass attenuation, airspace consolidation, poorly defined nodules. The triad of • Interlobular septal thickening, • Bronchovascular bundle thickening, and • Pleural effusionsare most suggestive AEP
  • 20. Eur Respir J 2013; 41: 402–409
  • 21. BAL
  • 22. Biopsy If BAL is not Revealing Biopsy, via a transbronchial or open lung biopsy or VATS approach depending upon the clinical and radiographic findings
  • 23. Cultures If there have been appropriate geographic exposures for coccidioidomycosis or clinical and radiographic findings suggestive of ABPA, fungal cultures should be obtained
  • 24. AEP is a diagnosis of exclusionand Requires : An acute febrile illness of short duration (usually less than one week) Hypoxemic respiratory failure Diffuse pulmonary opacities on chest radiograph BAL eosinophilia >25 percent Lung biopsy evidence of eosinophilic infiltrates (acute and/or organizing diffuse alveolar damage with prominent eosinophilia is the most characteristic finding) Absence of known causes of eosinophilic pneumonia, including drugs, infections.
  • 25. Treatment1. Glucocorticoid administration (preferably after blood extraction) is medically indicated if: Hypoxemia and in respiratory distress If the etiology is either AEP or a medication or toxin-elicited AEPRegimens :  In the absence of respiratory failure, initial treatment is with oral prednisone (40 to 60 mg daily).  In the presence of respiratory failure, methylprednisolone (60 to 125 mg every 6 hours)  Optimal Duration is not yet clear (2-4 wks no diff)* *Eur Respir J 2013; 41: 402–409
  • 26. After ImprovmentContinue oral prednisone in a dose of 40-60 mg per day for 2-4 weeks2. Supportive Therapy3. Smoking Cessation
  • 27. Recurrence Relapse is uncommon and is usually associated with resumption of cigarette smoking after initial cessation
  • 28. Refrences Up to date Eur Respir J 2013; 41: 402–409 Chest 2008; 133: 1174–1180 JAMA 2004; 292:2997–3005 Chest 2000;117:277–279 Semin Respir Crit Care Med. 2006 Apr;27(2):142-7.
  • 29. Thank You