Acute Eosinophilic Pneumonia
Differential Diagnosis
- Other eosinophilic pneumonias
- Known causes of acute eosinophilic pneumonia
- Diffuse alveolar damage / acute intertitial pneumonia
- Cryptogenic organizing pneumonia
- Desquamative interstitial pneumonia
| 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
- Drugs
- Check history
- Skin rash suggestive
- Organisms
- Check travel history
- Check stool ova and parasites
- Check serology for fungi and parasites
- Culture and stain lavage and biopsy specimens
- Allergic bronchopulmonary aspergillosis
- Bronchiolocentric
- May have necrotizing granulomatous bronchiolitis
- Mucus plugs common
- Culture, serology, biopsy identification
| 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 |
| Cryptogenic Organizing Pneumonia (BOOP) | Acute Eosinophilic Pneumonia |
|---|---|
| Subacute onset | Acute, fulminant onset |
| Eosinophils infrequent | Prominent eosinophils in lavage and biopsy specimens |
| Desquamative Interstitial Pneumonia | Acute Eosinophilic Pneumonia |
|---|---|
| Subacute onset | Acute, fulminant onset |
| Eosinophils infrequent | Prominent eosinophils in lavage and biopsy specimens |
