Chronic eosinophilic pneumonia causes a relatively specific pattern of histologic reaction, but a specific cause of this pattern is not usually identified.
A 71-year-old man presented with recurrent fevers, dyspnea, and hypoxemia. Chest imaging showed consolidation predominantly in the lower lobes and diffuse bilateral ground-glass opacities that had waxed and waned over a 6-month period. A diagnostic procedure was performed. A new Case Record summarizes.
Clinical Pearl
• What is the differential diagnosis for chronic peripheral lung infiltrates?
The differential diagnosis of chronic peripheral consolidation includes organizing pneumonia, chronic eosinophilic pneumonia, sarcoidosis, and cancer, including lymphoma and adenocarcinoma.
Clinical Pearl
• What is often the preferred method of lung biopsy for interstitial lung diseases?
The diagnostic yield of transbronchial biopsy is often limited by inadequate sample size of alveolar tissue and by crush artifact. Lung biopsy by means of video-assisted thoracic surgery (VATS), an approach that has mostly supplanted thoracotomy and minithoracotomy for this purpose, yields a larger sample of lung tissue than does transbronchial biopsy, thus enabling the pathologist to see a wider area of the lung architecture, with less crush artifact. The procedure has a low risk of complications, and therefore, it is often the preferred method of lung biopsy for interstitial lung diseases.
Morning Report Questions
Q: How does organizing pneumonia typically present?
A: Patients with organizing pneumonia typically present with several weeks of prodromal constitutional symptoms, followed by the abrupt onset of cough and dyspnea. Imaging studies show patchy migratory pulmonary infiltrates, possibly with ground-glass opacities and consolidation with air bronchograms. Pathological evaluation of an affected lung shows inflammation around small airways and plugs of granulation tissue filling these airways. Organizing pneumonia can be a primary phenomenon or it can be secondary to other processes, including drug reactions, cocaine use, collagen vascular diseases, hypersensitivity pneumonitis, infection, cancer, organ transplantation, infarcts, tumors, necrotizing granulomas, radiation therapy, toxic-fume exposure, and smoke inhalation. The treatment for organizing pneumonia is glucocorticoid therapy that is often administered for at least 1 year.
Q: What are some of the features of chronic eosinophilic pneumonia?
A: There are several eosinophilic lung disorders, including chronic eosinophilic pneumonia, acute eosinophilic pneumonia, eosinophilic granulomatosis with polyangiitis (formerly known as the Churg–Strauss syndrome), the hypereosinophilic syndrome, and eosinophilia associated with one of many other disorders. Chronic eosinophilic pneumonia tends to occur in nonsmoking women who are in their 40s, and features of the presentation include an indolent cough, dyspnea, fever, and migratory pulmonary infiltrates. Affected patients typically have eosinophilia in peripheral blood and in bronchoalveolar lavage fluid. Inflammatory markers in the peripheral blood may be elevated. It is important to rule out other causes of eosinophilia. Chronic eosinophilic pneumonia generally does not resolve spontaneously but does respond quickly to glucocorticoids.