Eosinophilic pneumonia differential diagnosis: Difference between revisions

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Latest revision as of 20:25, 19 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Acute eosinophilic pneumonia may be differentiated from other causes of pulmonary eosinophilia such as acute eosinophilic pneumonia, the transpulmonary passage of helminth larvae (Löffler syndrome), tropical pulmonary eosinophilia, eosinophilic granulomatosis with polyangiitis, allergic bronchopulmonary aspergillosis, and drugs and toxins.

Differential Diagnosis

Acute eosinophilic pneumonia may be differentiated from other causes of pulmonary eosinophilia.

Acute eosinophilic pneumonia (AEP)

  • The cause of acute eosinophilic pneumonia is unknown.
  • Some investigators have suggested that AEP is an acute hypersensitivity reaction to an unidentified inhaled antigen in an otherwise healthy individual.

Transpulmonary passage of helminth larvae (Löffler syndrome)

  • Three types of helminthsAscaris (A. lumbricoidesA. suum), hookworms (Ancylostoma duodenaleNecator americanus), and Strongyloides stercoralis, have larvae that reach the lungs, penetrate into alveoli, and ascend the airways then reach the gastrointestinal tract.
  • Ascaris is the most common cause of Löffler syndrome worldwide.

Tropical pulmonary eosinophilia

Eosinophilic granulomatosis with polyangitis

  • Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) is a vasculitic disorder often characterized by sinusitis, asthma, and prominent peripheral blood eosinophilia.
  • It is the sole form of vasculitis that is associated with both eosinophilia and frequent lung involvement. In addition to the lungs, the skin and the cardiovascular, gastrointestinal, renal, and neurologic systems may also be involved.

Allergic bronchopulmonary aspergillosis

  • Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity reaction that occurs when airways become colonized by Aspergillus. 
  • Repeated episodes of bronchial obstruction, inflammation, and mucoid impaction can lead to bronchiectasis, fibrosis, and respiratory compromise.
  • Immunologic responses elicited by Aspergillus fumigatus are responsible for this syndrome.

Drugs and toxins

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a drug-induced hypersensitivity reaction that includes skin eruption, eosinophilia, atypical lymphocytosis, lymphadenopathy, and kidney involvement. Drugs causing DRESS are:

Clinical Picture Laboratory diagnosis Imaging Pulmonary function tests Treatment
Acute eosinophilic pneumonia
  • Bronchoalveolar lavage showing eosinophilia is often the key to the diagnosis of IAEP.
  • Bronchoalveolar lavage showing eosinophilia may persist for several weeks.
  • Bilateral infiltrates
  • Poorly defined nodules
  • Ground-glass attenuation
  • Interlobular septal thickening
  • Bilateral pleural effusion
  • Thickening of bronchovascular bundles
Chronic eosinophilic pneumonia
  • Onset >2–4 week
Allergic bronchopulmonary aspergillosis
Eosinophilic granulomatosis with polyangitis 3 phases:

20,000/mm

  • ANCAs are found in only 40% of patients
  • Pulmonary infiltrates: ill-defined opacities with peripheral predominance
  • Airflow obstruction is present in 70% of patients
  • Mild airflow obstruction may persist in 30% to 40% of patients

An initial methylprednisolone

bolus (15 mg/kg per day for 1–3 days) may be

indicated in the most severe cases.

References

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