Surgical Pathology Criteria

Acute Eosinophilic Pneumonia

Differential Diagnosis

Simple Eosinophilic Pneumonia Acute Eosinophilic Pneumonia Chronic Eosinophilic Pneumonia
Asymptomatic to mild symptoms Fulminant respiratory insufficiency Chronic dyspnea, cough
Blood eosinophils mildly elevated Blood eosinophils normal to mildly elevated Blood eosinophils >1000/mm3
No direct treatment required Steroid responsive, no relapses Steroid responsive, 50% relapse

 

Known causes of eosinophilic pneumonia must be ruled out

 

Acute Interstitial Pneumonia / Diffuse Alveolar Damage Acute Eosinophilic Pneumonia
Eosinophils infrequent Prominent eosinophils in lavage and biopsy specimens
Not steroid responsive, poor prognosis Steroid responsive, no relapses
Diffuse alveolar damage pattern may be seen in acute eosinophilic pneumonia

 

Cryptogenic Organizing Pneumonia (BOOP) Acute Eosinophilic Pneumonia
Subacute onset Acute, fulminant onset
Eosinophils infrequent Prominent eosinophils in lavage and biopsy specimens
BOOP pattern may be seen in acute eosinophilic pneumonia

 

Desquamative Interstitial Pneumonia Acute Eosinophilic Pneumonia
Subacute onset Acute, fulminant onset
Eosinophils infrequent Prominent eosinophils in lavage and biopsy specimens
Following steroid treatment, eosinophils may be harder to identify

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