Dr. Ashwin Subramani
Mentor: Dr. Jeff Wilson
3/2/2021
Eosinophilic Lung Syndromes
Criteria:
· 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)
Categories:
· 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
References:
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.
