Dr. Ashwin Subramani

Mentor: Dr. Jeff Wilson


Eosinophilic Lung Syndromes


·         Peripheral blood eosinophilia: >500×109 cells/L (normal: 35-350×109 cells/L)

o   this one may not always be present! Confirm with BAL if high suspicion

·         BAL fluid eosinophilia: >5% eosinophils (normal: <1% eosinophils)

o   gold standard

·         Eosinophilic infiltration of lung parenchyma (biopsy)


·         Drugs and Toxins

o   Common drugs: daptomycin, mesalamine, sulfasalazine, minocycline

o   Common toxins: cigarette smoke, fireworks, Scotchguard

·         Infections

o   Helminthes

§  Loeffler’s syndrome

o   Fungal (aspergillosis, coccidiomycosis), HIV, mycobacterium

·         Auto-Immune

o   Churg-Strauss

o   Hypereosinophilic Syndrome

o   Sarcoidosis

·         Malignancy

o   Leukemia and lymphoma

·         Idiopathic

o   Must rule out all of the above first!

Acute and Chronic Idiopathic Eosinophilic Pneumonia

Philit’s Diagnostic Criteria (Acute):

·         acute febrile illness: <1 month

·         hypoxemia

·         bilateral diffuse pulmonary infiltrates

·         BAL or lung biopsy criteria

·         Absence of known causes of eosinophilic lung syndromes


Chronic Idiopathic Eosinophilic Pneumonia Diagnostic Criteria:

·         >1 month (usually dx 5-6 months after onset)

·         less severe hypoxemia

·         more peripheral pulmonary radiographic findings

·         BAL or lung biopsy criteria

·         Absence of known causes of eosinophilic lung syndromes


Treatment: Systemic Glucocorticoid Therapy



Allen, J., & Davis, W. (1994). Eosinophilic Lung Diseases. American Journal of Respiratory and      Critical Care Medicine, 150 (5) 1423-39.

Bartal, C., Sagt, I., & Barski, L. (2018). Drug-induced eosinophilic pneumonia. Medicine, 97(4).

Chen, E., & Khoury, P. (2021). Approach to Eosinophilia Presenting with Pulmonary Symptoms.   Chest, 159(2) 507-15.

Giacomi, F., Vassalo, R., Yi, E., & Ryu, J. (2017). Acute Eosinophilic Pneumonia. Causes,     Diagnosis, and Management. American Journal of Respiratory and Critical Care     Medicine, 197(6).

Janz, D., O’Neal, H., & Ely, E. (2009). Acute eosinophilic pneumonia: A case report and review of the literature. Critical Care Medicine 37(4) 1470-4.

Philip et. al. (2002). Idiopathic acute eosinophilic pneumonia: a study of 22 patients. American   Journal of Respiratory and Critical Care Medicine, 199(9) 1235-9.

Ravin, K., & Loy, M. (2016). The Eosiniophil in Infection. Clinical Reviews in Allergy and     Immunology, 50(2) 214-227.