Fræðigrein

Læknablaðið 2007; 93: 109-14

Objective: The objective of the study was to describe the incidence and clinical features of chronic eosinophilic pneumonia (CEP) in Iceland and review recent literature.

Material and methods: Retrospective study where information was obtained from clinical charts from 1990-2004. Records, imaging studies and histopathology were evaluated.

Results: During the study period 10 individuals were diagnosed with CEP, 7 males and 3 females. Mean age was 58 years. None of the patients was a current smoker. The incidence of CEP during the study period was 0.23 per 100.000/year but increased to 0.54 per 100.000/year during the last 5 years of the study period. Clinical symptoms were malaise, cough, dyspnea, sweating and weight loss. Sedimentation rate was 72 mm/h and C-reactive protein (CRP) 125 mg/L. Eight of the ten patients had increase in blood eosinophils. On chest auscultation crackles were heard in seven patients and wheezing in three. Forced vital capacity (FVC) was 75% of predicted value and forced expiratory volume in one second (FEV1) was 73% of predicted. Mean PO2 was 68 mmHg. All the patients had classic diffuse bilateral opacities on chest radiograph that most commonly were peripheral. All patients were treated with corticosteroids and responded well. The average initial dose of Prednisolone was 42.5 mg per day. Seven of the patients relapsed but they all responded well to repeated treatment.

Conclusions: Chronic eosinophilic pneumonia is a rare disorder but it has specific radiologic and histologic features. It is important to think of the disease in patients with diffuse infiltrates that are resistant to antibiotics. CEP responds well to corticosteroids but there is a high relapse rate, which also responds to treatment.

 

Figure 1. Chest radiograph from a patient with chronic eosinophilic pneumonia with typical bilateral peripheral infiltrates.

Figure 2.  Transbronchial biopsy showing alveoli filled with eosinophils and variable numbers of macrophages. Also noted is mild chronic interstitial inflammation (H&E, x 25).

Figure 3. Transbronchial biopsy. Alveoli filled with eosinophils admixed with some macrophages (H&E, x 40).

 

 

Table 1. Clinical features in patients with chronic eosinophilic pneumonia.

Patient	Sex	Age at diagnosis	Symptoms and signs	Asthma	Smoking status	Chest auscultation	Laboratory values: ESR mm/hr, CRP mg/L	Initial Treatment Prednisolon	Relapse
1	Male	68 years	Malaise, fever, sweat, dyspnea and cough.	No	Former	Crackles	ESR, 64, CRP 101. Eos. normal.	30 mg	No
2	Female	62 years	Malaise, cough, fever.	Yes	Former	Crackles	ESR 23, CRP 26. Eos. 32%.	60 mg	Yes
3	Female	36 years	Malaise, cough, sweat, fever, weight loss and dyspnea.	No	Never	Crackles	ESR 94, CRP 426. Eos. 25%.	40 mg	No
4	Male	77 years	Malaise, cough, fever, and sweat.	Yes	Never	Rhonchi	ESR 58, CRP 41. Eos. 45%	40 mg	Yes
5	Male	60 years	Malaise, cough, dyspnea, weight loss, sweat and fever.	Yes	Former	Crackles	ESR 40. Eos. 27%.	50 mg	Yes
6	Male	52 years	Malaise, fever, cough, sweat and weight loss.	Yes	Former	Rhonchi	ESR 67, CRP 54. Eos. 50%.	40 mg	Yes
7	Female	24 years	Malaise, fever, cough.	Yes	Former	Crackles	ESR 124. Eos. 14%.	60 mg	Yes
8	Male	71 years	Malaise, fever, cough, sweat and weight loss.	Yes	Former	Crackles/ rhonchi	ESR 110. CRP 250. Eos. normal.	40 mg	Yes
9	Male	50 years	Malaise, dyspnea, fever and cough.	No	Former	Crackles	ESR 22, CRP 31. Eos. 18%	40 mg	Yes
10	Male	76 years	Malaise, dyspnea, fever and cough.	No	Never	Normal	ESR 116. Eos. 9%.	40 mg	No