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Acute eosinophilic pneumonia
Last reviewed: 23.04.2024
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Acute eosinophilic pneumonia is characterized by rapid eosinophilic infiltration of the interstitial spaces of the lung.
The incidence and prevalence of acute eosinophilic pneumonia is not known. Disease acute eosinophilic pneumonia can occur at any age, but most patients are sick between the ages of 20 and 40; men are sick 21 times more often than women.
[What causes acute eosinophilic pneumonia?
Its cause is not known, but acute eosinophilic pneumonia may be an acute hypersensitivity reaction to an unidentified antigen found in the respiratory tract in a conditionally healthy person. Smoking and other substances inhaled in the form of smoke can make a difference.
Symptoms of acute eosinophilic pneumonia
Acute eosinophilic pneumonia causes an acute increase in body temperature of short duration (usually <7 days). Develop unproductive cough, shortness of breath, malaise, myalgia, night sweats and pleural pain in the chest. Symptoms of acute eosinophilic pneumonia can also be tachypnea, a significant increase in body temperature (often> 38.5 ° C), bilateral basal inspiratory rales and, sometimes, wheezing when forced exhalation. Acute eosinophilic pneumonia often manifests as acute respiratory failure requiring artificial ventilation of the lungs. In rare cases, hyperdynamic shock can develop.
Diagnosis of acute eosinophilic pneumonia
Diagnosis of acute eosinophilic pneumonia is based on the analysis of clinical manifestations, the results of standard studies and is confirmed by bronchoscopy. It is established by excluding other known causes of eosinophilic pneumonia and respiratory failure. A clinical blood test in most patients demonstrates a markedly increased amount of eosinophils. The values of ESR and IgE concentrations are also high, but nonspecific.
When radiographing chest organs, initially only a slight enhancement of the pulmonary pattern or changes in the type of opaque glass, often with the presence of Curly lines of type B, may be detected. In the initial stage of the disease, isolated alveolar (approximately 25% of cases) darkening or strengthening of the pulmonary pattern (also in about 25% of cases). The changes differ from those in chronic eosinophilic pneumonia, in which the dimming is limited to the peripheral parts of the lungs. Small pleural effusions, often bilateral, occur in two thirds of patients. The results of HRCT are always pathological; two-sided asymmetrical focal dimming of the type of frosted glass or strengthening of the pulmonary pattern are revealed. In studies of pleural fluid, pronounced eosinophilia at high pH is noted. Lung function tests often indicate restrictive disorders with reduced diffusion capacity for carbon monoxide (DLCO).
Bronchoscopy should be performed for the purpose of carrying out lavage and, sometimes, biopsy. Wash waters of bronchoalveolar lavage often contain a large number and percentage (> 25%) of eosinophils. The most frequent histological changes correspond to eosinophilic infiltration with an acute and organized diffuse lesion of the alveoli, but biopsy is performed only in rare cases.
Treatment of acute eosinophilic pneumonia
Some patients recover spontaneously. In most cases, the treatment of acute eosinophilic pneumonia consists in the appointment of prednisolone (in a dose of 40 to 60 mg, orally, once a day). In the presence of respiratory failure, the prescription of methylprednisolone (in a dose of 60 to 125 mg, every 6 hours) is preferred.
What is the prognosis of acute eosinophilic pneumonia?
Acute eosinophilic pneumonia has a favorable prognosis; the response to glucocorticoid therapy and complete recovery without the development of relapse are almost always observed. Pleural effusions are resolved more slowly than parenchymal infiltrates.