Definition
Chronic respiratory disorder associated with pulmonary eosinophil infiltration
Covered Separately
Diagnostic Criteria
Clinical
Chronic dyspnea, cough
Respiratory failure uncommon
Weight loss, fever, night sweats common
May have history of asthma, atopy
Mean age 45
Rapid response to steroids
X-ray
Bilateral diffuse opacities with peripheral accentuation
"Photographic negative of pulmonary edema" classic but seen in <50%
Pathology
Hypereosinophilia must be demonstrated in the blood or lung to make the diagnosis
Blood eosinophils usually >1000/mm3
Steroid treament may dramatically reduce eosinophilia
Bronchoalveolar lavage (BAL) fluid shows eosinophils > lymphocytes
Tissue biopsy shows prominent eosinophilic infiltrate
Biopsy is not usually necessary for diagnosis but may help rule out infection
Intra-alveolar and usually interstitial
May have eosinophilic microabscesses with central necrosis
May invade vessel walls but no necrosis or granulomatous vasculitis
5-25% eosinophils is consistent with diagnosis, >25% is suggestive
Eosinophils are rare in normal lung (<2%)
Sarcoid like granulomas without necrosis may be present
Organizing pneumonia may be present
Known causes must be ruled out
Drugs including antibiotics, non-steroidal anti-inflammatory, anti-hypertensive, heroin, cocaine
Organisms including fungi and parasites
Allergic bronchopulmonary aspergillosis
Gerald J Berry MD
Original posting/updates: 11/20/10
Differential Diagnosis
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
Churg-Strauss Syndrome
Acute Eosinophilic Pneumonia
Heart, kidneys, skin, gi, nervous system, other organs involved
Restricted to lung
pANCA and anti-myeloperoxidase positive in 50%
pANCA and anti-myeloperoxidase negative
Granulomatous vasculitis on lung biopsy
No granulomatous vasculitis
Idiopathic Hypereosinophilic Syndrome
Chronic Eosinophilic Pneumonia
Blood eosinophilia >1500/mm3 for 6 months
Blood eosinophilia >1000/mm3
Heart, other organs involved
Restricted to lung
No asthma
Asthma may be seen
Langerhans Cell Histiocytosis Chronic Eosinophilic Pneumonia
Predominantly interstitial process, intra-alveolar macrophages only focally present
Predominantly intra-alveolar process
Composed of Langerhans cells with variable numbers of eosinophils
Prominent eosinophils, no Langerhans cells
Produces stellate scars
Lacks scarring
Histiocytes with folded nuclei
Histiocytes with round nuclei
S100, CD1a, langerin positive
S100, CD1a, langerin negative
Classification / Lists
Idiopathic Interstitial Lung Diseases
Other Diffuse Parenchymal Lung Diseases
Bibliography
Travis WD, Colby TV, Koss MN, Rosado-de-Christenson ML, Müller NL, King TE Jr. Non-neoplastic Disorders of the Lower Respiratory Tract, AFIP Atlas of Nontumor Pathology, First Series, Fascicle 2, 2002.
Tazelaar HD, Linz LJ, Colby TV, Myers JL, Limper AH. Acute eosinophilic pneumonia: histopathologic findings in nine patients. Am J Respir Crit Care Med. 1997 Jan;155(1):296-302.
Pope-Harman AL, Davis WB, Allen ED, Christoforidis AJ, Allen JN. Acute eosinophilic pneumonia. A summary of 15 cases and review of the literature. Medicine (Baltimore). 1996 Nov;75(6):334-42.
Jederlinic PJ, Sicilian L, Gaensler EA. Chronic eosinophilic pneumonia. A report of 19 cases and a review of the literature. Medicine (Baltimore). 1988 May;67(3):154-62.
Marchand E, Cordier JF. Idiopathic chronic eosinophilic pneumonia. Orphanet J Rare Dis. 2006 Apr 6;1:11..
