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Haraguchi T, Tashiro H, Takahashi K, Kurihara Y, Sadamatsu H, Miyahara N, Hiratsuka M, Kimura S, Sueoka-Aragane N. Idiopathic eosinophilic pleurisy: A practical diagnostic approach. Respir Med Case Rep 2021; 33:101430. [PMID: 34401274 PMCID: PMC8348509 DOI: 10.1016/j.rmcr.2021.101430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 04/30/2021] [Accepted: 05/08/2021] [Indexed: 10/28/2022] Open
Abstract
A 37-year-old man with fever, cough, and dyspnea with no medical history developed an eosinophilic pleural effusion and blood eosinophilia. No evidence of malignancy or pathogens was detected in the pleural effusion, and the pleural specimen obtained by thoracoscopy showed eosinophilic infiltration with inflammatory granulation tissue without fibrinoid necrosis or malignant cells. Since a myeloproliferative disorder was also excluded, the diagnosis was idiopathic eosinophilic pleurisy. Corticosteroid treatment was started and then slowly tapered, and the eosinophilic pleural effusion resolved. Considering the various etiologies of eosinophilic pleurisy, a practical clinical approach to the investigation and diagnosis of eosinophilic pleurisy is presented.
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Affiliation(s)
- Tetsuro Haraguchi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University Hospital, Saga, Japan
| | - Hiroki Tashiro
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University Hospital, Saga, Japan
| | - Koichiro Takahashi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University Hospital, Saga, Japan
| | - Yuki Kurihara
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University Hospital, Saga, Japan
| | - Hironori Sadamatsu
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University Hospital, Saga, Japan
| | - Naofumi Miyahara
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University Hospital, Saga, Japan
| | - Masafumi Hiratsuka
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University Hospital, Saga, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University Hospital, Saga, Japan
| | - Naoko Sueoka-Aragane
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University Hospital, Saga, Japan
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2
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Tan S, Takano A, Ho A, Tan KL. Asthmatic adult with marked blood eosinophilia: is it truly asthma? BMJ Case Rep 2018; 2018:bcr-2017-222344. [PMID: 29735492 PMCID: PMC5950557 DOI: 10.1136/bcr-2017-222344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A middle-aged woman presented with symptoms suggestive of allergic asthma but with markedly elevated peripheral eosinophilia. She did not respond to inhaled corticosteroids, thereby prompting further investigations. Chest radiograph was normal. CT of the chest revealed bi-apical ground glass opacities. Bronchoalveolar lavage revealed predominantly eosinophilic yield. Autoimmune screen was negative. Bone marrow biopsy showed a normocellular marrow with increased eosinophils. A diagnosis of chronic eosinophilic pneumonia (CEP) was made after exclusion of other causes of eosinophilia. Treatment of her CEP with systemic corticosteroids (prednisolone 0.5 mg/kg/day) resulted in dramatic improvement in symptoms and peripheral eosinophilia.
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Affiliation(s)
- Shera Tan
- Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Angela Takano
- Department of Pathology, Singapore General Hospital, Singapore
| | - Aloysius Ho
- Department of Hematology, Singapore General Hospital, Singapore
| | - Keng Leong Tan
- Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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3
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Memory-type ST2 +CD4 + T cells participate in the steroid-resistant pathology of eosinophilic pneumonia. Sci Rep 2017; 7:6805. [PMID: 28754914 PMCID: PMC5533714 DOI: 10.1038/s41598-017-06962-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 06/21/2017] [Indexed: 01/21/2023] Open
Abstract
The lung develops an unique epithelial barrier system to protect host from continuous invasion of various harmful particles. Interleukin (IL-)33 released from epithelial cells in the lung drives the type 2 immune response by activating ST2− expressed immune cells in various allergic diseases. However, the involvement of memory-type ST2+CD4+ T cells in such lung inflammation remains unclear. Here we demonstrated that intratracheal administration of IL-33 resulted in the substantial increase of numbers of tissue-resident memory-type ST2+CD4+ T cells in the lung. Following enhanced production of IL-5 and IL-13, eosinophilic lung inflammation sequentially developed. IL-33-mediated eosinophilic lung inflammation was not fully developed in T cell-deficient Foxn1nu mice and NSG mice. Dexamethasone treatment showed limited effects on both the cell number and function of memory-type ST2+CD4+ T cells. Thus our study provides novel insight into the pathogenesis of eosinophilic lung disease, showing that memory-type ST2+CD4+ T cells are involved in IL-33-induced eosinophilic inflammation and elicited steroid-resistance.
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Sriratanaviriyakul N, La HH, Albertson TE. Chronic eosinophilic pneumonia presenting with ipsilateral pleural effusion: a case report. J Med Case Rep 2016; 10:227. [PMID: 27520469 PMCID: PMC4983070 DOI: 10.1186/s13256-016-1005-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/11/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Chronic eosinophilic pneumonia is a rare idiopathic interstitial lung disease. The nearly pathognomonic radiographic finding is the peripheral distribution of alveolar opacities. Pleural effusions are rarely seen. We report a case of chronic eosinophilic pneumonia with transudative eosinophilic pleural effusion. CASE PRESENTATION A 57-year-old Hispanic woman, a nonsmoker with a history of controlled asthma, presented to the hospital with unresolving pneumonia despite three rounds of antibiotics over a 2-month period. She was later diagnosed with chronic eosinophilic pneumonia based on the presence of peripheral blood eosinophilia, the peripheral distribution of alveolar infiltrates on chest radiograph, and a lung parenchymal biopsy with infiltrates of eosinophils. Upon presentation, our patient had a right-sided moderate-sized pleural effusion. The pleural fluid profile was consistent with a transudative effusion with eosinophil predominance. Our patient responded promptly to oral corticosteroid treatment in a few days. The pulmonary infiltrates and pleural effusion subsided on a 1-month follow-up chest radiograph after starting corticosteroid treatment. CONCLUSIONS We report the first case of chronic eosinophilic pneumonia presenting with pneumonia with ipsilateral transudative eosinophilic pleural effusion. Like other cases of chronic eosinophilic pneumonia, early recognition and diagnosis is essential and prompt treatment with corticosteroids is the mainstay of therapy. Pleural effusion resolved without the further need for therapeutic thoracentesis.
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Affiliation(s)
- Narin Sriratanaviriyakul
- University of California, Davis, USA. .,Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, 4150 V Street, Suite 3100, Sacramento, CA, 95817, USA. .,VA Northern California Health Care System, 10535 Hospital Way, Mather, CA, 95655, USA. .,The Queen's Medical Center, Department of Internal Medicine, 1301 Punchbowl Street, Honolulu, HI, 96813, USA.
| | - Hanh H La
- University of California, Davis, USA.,VA Northern California Health Care System, 10535 Hospital Way, Mather, CA, 95655, USA.,Division of Hematology and Oncology, 4501 X Street, Sacramento, CA, 95817, USA
| | - Timothy E Albertson
- University of California, Davis, USA.,Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, 4150 V Street, Suite 3100, Sacramento, CA, 95817, USA.,VA Northern California Health Care System, 10535 Hospital Way, Mather, CA, 95655, USA
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5
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Kagohashi K, Ohara G, Kurishima K, Kawaguchi M, Nakayama H, Ishikawa H, Satoh H. Chronic Eosinophilic Pneumonia with Subpleural Curvilinear Shadow. ACTA MEDICA (HRADEC KRÁLOVÉ) 2016; 54:45-8. [DOI: 10.14712/18059694.2016.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We report a rare case of chronic eosinophilic pneumonia with subpleural curvilinear shadow. CT scan showed a patchy consolidation in the bilateral upper lungs. In addition, subpleural curvilinear shadow was found in the bilateral upper lungs. A bronchoalveolar lavage obtained from the right middle lobe showed 25 % eosinophils. Although very rare, we should therefore keep in mind that patients, who have patchy consolidation with areas of subpleural curvilinear shadow in the bilateral upper lungs, may have chronic eosinophilic pneumonia.
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Kim E, Kim C, Yang B, Kim M, Kang J, Lee J. Intrapleural corticosteroid injection in eosinophilic pleural effusion associated with undifferentiated connective tissue disease. Tuberc Respir Dis (Seoul) 2013; 75:161-4. [PMID: 24265645 PMCID: PMC3833937 DOI: 10.4046/trd.2013.75.4.161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/17/2013] [Accepted: 07/24/2013] [Indexed: 11/24/2022] Open
Abstract
Eosinophilic pleural effusion (EPE) is defined as a pleural effusion that contains at least 10% eosinophils. EPE occurs due to a variety of causes such as blood or air in the pleural space, infection, malignancy, or an autoimmune disease. Undifferentiated connective tissue disease (UCTD) associated with eosinophilic pleural effusion is a rare condition generally characterized by the presence of the signs and symptoms but not fulfilling the existing classification criteria. We report a case involving a 67-year-old man with UCTD and EPE, who has been successfully treated with a single intrapleural corticosteroid injection.
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Affiliation(s)
- Eunjung Kim
- Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Abstract
This review starts with discussions of several infectious causes of eosinophilic pneumonia, which are almost exclusively parasitic in nature. Pulmonary infections due specifically to Ascaris, hookworms, Strongyloides, Paragonimus, filariasis, and Toxocara are considered in detail. The discussion then moves to noninfectious causes of eosinophilic pulmonary infiltration, including allergic sensitization to Aspergillus, acute and chronic eosinophilic pneumonias, Churg-Strauss syndrome, hypereosinophilic syndromes, and pulmonary eosinophilia due to exposure to specific medications or toxins.
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9
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Campos LEM, Pereira LFF. Pulmonary eosinophilia. J Bras Pneumol 2010; 35:561-73. [PMID: 19618037 DOI: 10.1590/s1806-37132009000600010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 03/06/2009] [Indexed: 01/15/2023] Open
Abstract
Pulmonary eosinophilia comprises a heterogeneous group of diseases defined by eosinophilia in pulmonary infiltrates (bronchoalveolar lavage fluid) or in tissue (lung biopsy specimens). Although the inflammatory infiltrate is composed of macrophages, lymphocytes, neutrophils and eosinophils, eosinophilia is an important marker for the diagnosis and treatment. Clinical and radiological presentations can include simple pulmonary eosinophilia, chronic eosinophilic pneumonia, acute eosinophilic pneumonia, allergic bronchopulmonary aspergillosis and pulmonary eosinophilia associated with a systemic disease, such as in Churg-Strauss syndrome and hypereosinophilic syndrome. Asthma is frequently concomitant and can be a prerequisite, as in allergic bronchopulmonary aspergillosis and Churg-Strauss syndrome. In diseases with systemic involvement, the skin, the heart and the nervous system are the most affected organs. The radiological presentation can be typical, or at least suggestive, of one of three types of pulmonary eosinophilia: chronic eosinophilic pneumonia, acute eosinophilic pneumonia and allergic bronchopulmonary aspergillosis. The etiology of pulmonary eosinophilia can be either primary (idiopathic) or secondary, due to known causes, such as drugs, parasites, fungal infection, mycobacterial infection, irradiation and toxins. Pulmonary eosinophilia can be also associated with diffuse lung diseases, connective tissue diseases and neoplasia.
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Affiliation(s)
- Luiz Eduardo Mendes Campos
- Residency Program in Pulmonology and Respiratory Outpatient Clinic. Júlia Kubitschek Hospital, Fundação Hospitalar do Estado de Minas Gerais - FHEMIG, Hospital Foundation of the State of Minas Gerais - Belo Horizonte, Brazil.
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Lahoz Tornos A, Orcastegui Candial J. Neumonía eosinófila crónica en la provincia de Soria (1995-2004). Revisión de la bibliografía. Rev Clin Esp 2009; 209:131-5. [DOI: 10.1016/s0014-2565(09)70878-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
Eosinophils may infiltrate the lung tissue, thus impairing gas exchange and causing several symptoms as dyspnea, fever, and cough. This process may be secondary to several factors, including drugs or parasite migration, or primary (idiopathic). Acute eosinophilic pneumonia is life-threatening and presents frequently in young smokers as an acute hypoxemic respiratory failure of generally less than a week with bilateral lung infiltrates, frequently misdiagnosed as severe community-acquired pneumonia. This patients present without peripheral eosinophilia but usually have more than 25% eosinophils on bronchoalveolar fluid. Chronic eosinophilic pneumonia is a protracted disease of usually more than a month before presentation, with a predilection for middle aged asthmatic patients. Hypoxemia is mild-moderate, and there are usually more than 1,000 eosinophils/mm3 of peripheral blood. Bronchoalveolar fluid has high eosinophil levels (usually more than 25%). Migratory peripheral infiltrates are seen in the chest x-ray film. Both acute and chronic eosinophilic pneumonia are treated by glucocorticoids and respiratory support as well as avoidance of any recognized trigger.
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Affiliation(s)
- Uriel Katz
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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12
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Valente C, André S, Catarino A, Loureiro M, Baganha MF. Pneumonia eosinofílica crónica idiopática – A propósito de um caso clínico. REVISTA PORTUGUESA DE PNEUMOLOGIA 2008; 14:551-9. [DOI: 10.1016/s0873-2159(15)30261-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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13
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Aktoğu Ozkan S, Erer OF, A Yalçin Y, Yuncu G, Aydoğdu Z. Hydatid cyst presenting as an eosinophilic pleural effusion. Respirology 2007; 12:462-4. [PMID: 17539858 DOI: 10.1111/j.1440-1843.2007.01054.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A 61-year-old woman presented with an eosinophilic pleural effusion, secondary to transdiaphragmatic intrapleural spread of an hepatic hydatid cyst. Right posterolateral thoracotomy and frenotomy revealed a loculated pleural effusion associated with a 10 x 8 cm hydatid cyst in the posterior segment of the liver. Hydatid disease should be included in the differential diagnosis of eosinophilic pleural effusions in endemic regions.
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Affiliation(s)
- Serir Aktoğu Ozkan
- Department of Respiratory Medicine, Izmir Training Hospitla for Thoracic Medicine and Surgery, Yenişehir, Izmir, Turkey.
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Jeong YJ, Kim KI, Seo IJ, Lee CH, Lee KN, Kim KN, Kim JS, Kwon WJ. Eosinophilic lung diseases: a clinical, radiologic, and pathologic overview. Radiographics 2007; 27:617-37; discussion 637-9. [PMID: 17495282 DOI: 10.1148/rg.273065051] [Citation(s) in RCA: 151] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Eosinophilic lung diseases are a diverse group of pulmonary disorders associated with peripheral or tissue eosinophilia. They are classified as eosinophilic lung diseases of unknown cause (simple pulmonary eosinophilia [SPE], acute eosinophilic pneumonia [AEP], chronic eosinophilic pneumonia [CEP], idiopathic hypereosinophilic syndrome [IHS]), eosinophilic lung diseases of known cause (allergic bronchopulmonary aspergillosis [ABPA], bronchocentric granulomatosis [BG], parasitic infections, drug reactions), and eosinophilic vasculitis (allergic angiitis, granulomatosis [Churg-Strauss syndrome]). The percentages of eosinophils in peripheral blood and bronchoalveolar lavage fluid are essential parts of the evaluation. Chest computed tomography (CT) demonstrates a more characteristic pattern and distribution of parenchymal opacities than does conventional chest radiography. At CT, SPE and IHS are characterized by single or multiple nodules with a surrounding ground-glass-opacity halo, AEP mimics radiologically hydrostatic pulmonary edema, and CEP is characterized by nonsegmental airspace consolidations with peripheral predominance. ABPA manifests with bilateral central bronchiectasis with or without mucoid impaction. The CT manifestations of BG are nonspecific and consist of a focal mass or lobar consolidation with atelectasis. The most common CT findings in Churg-Strauss syndrome include sub-pleural consolidation with lobular distribution, centrilobular nodules, bronchial wall thickening, and interlobular septal thickening. The integration of clinical, radiologic, and pathologic findings facilitates the initial and differential diagnoses of various eosinophilic lung diseases.
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Affiliation(s)
- Yeon Joo Jeong
- Department of Diagnostic Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, 1-10, Ami-Dong, Seo-gu, Pusan 602-739, Korea.
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15
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Avnon LS, Abu-Shakra M, Flusser D, Heimer D, Sion-Vardy N. Pleural effusion associated with rheumatoid arthritis: what cell predominance to anticipate? Rheumatol Int 2007; 27:919-25. [PMID: 17294192 DOI: 10.1007/s00296-007-0322-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2006] [Accepted: 01/11/2007] [Indexed: 10/23/2022]
Abstract
Pleural involvement is the most frequent manifestation of rheumatoid arthritis (RA) in the chest. We report here two patients who presented with large exudative pleural effusions and subsequently developed sero-positive RA. In both cases, the differential cell count of the pleural effusion suggested empyema. A literature review identified that RA-associated pleural effusion afflicts more men than women and 95% of the patients have high titers of rheumatoid factor (RF). In 46% of cases, RA-associated pleural effusion is diagnosed in close temporal relationship with the diagnosis of RA. The effusion is an exudate and is characterized by low pH and glucose level, and high lactic dehydrogenase (LDH) and cell count. At diagnosis there is a tendency for predominant neutrophils to occur consistent with an empyema and 7-11 days later, the cells in the pleural effusion are replaced by lymphocytes. Pleural effusion with predominant eosinophilia is rare. RA patients with acidic effusion and low glucose content with neutrophils predominance should be treated with thoracic drainage and antibiotics until an infection is ruled out. The histo-pathologic findings in pleural fluid of tadpole cells and multinucleated giant cells and the replacement of the mesothelial cells on the parietal pleural surface with a palisade of macrophage derived cells are described as pathogonomic for RA. Treatment with systemic steroids and intra-pleural steroids are effective in most cases.
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Affiliation(s)
- L Sølling Avnon
- Pulmonary Clinic, Soroka University Medical Center, and Faculty of Health Sciences at Ben Gurion University of the Negev, Beer Sheva, Israel
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Olson AL, Cosgrove GP, Brown KK, Schwarz MI. A 63-year-old man with a persistent pulmonary infiltrate and pleural effusion. Chest 2007; 130:1929-34. [PMID: 17167018 DOI: 10.1378/chest.130.6.1929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Amy L Olson
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, 4200 East Ninth Ave, C272, Denver, CO 80262, USA.
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17
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Miranowski AC, Ditto AM. A 59-year-old woman with fever, cough, and eosinophilia. Ann Allergy Asthma Immunol 2006; 96:483-8. [PMID: 16597085 DOI: 10.1016/s1081-1206(10)60918-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Anne C Miranowski
- Department of Medicine, Division of Allergy-Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
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Abstract
PURPOSE OF REVIEW This review reports recent information on the occurrence of pleural effusions in association with disorders that produce interstitial parenchymal lung disease. RECENT FINDINGS The occurrence of effusions has been expanded to include systemic sclerosis, polymyositis-dermatomyositis, several drugs, and several miscellaneous causes of interstitial lung disease (ILD). SUMMARY Pleural effusions occur in patients with various forms of interstitial lung disease. The effusions require a clinical evaluation to exclude complications of therapy and coexisting conditions unrelated to the underlying ILD.
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Affiliation(s)
- Kristin B Highland
- Division of Pulmonary Critical Care Medicine and Allergy, Medical University of South Carolina, Charleston, South Carolina 29425, USA
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20
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Abstract
Valproic acid is a carboxylic acid used for the treatment of both seizure and mood disorders. Its association with pleural fluid eosinophilia has been reported once in the English language literature. We present another case of valproic acid-induced pleural fluid eosinophilia associated with fever and peripheral blood eosinophilia. Extensive evaluation failed to reveal any other cause of eosinophilic pleural effusion, and the effusion resolved with discontinuance of valproic acid. Rechallenge with valproic acid produced recurrent symptoms. Valproic acid should be considered a possible cause of eosinophilic pleural effusion.
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Affiliation(s)
- Jeffrey D Kravetz
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
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Abstract
Eosinophilic pleural effusions, defined as a pleural effusion that contains at least 10% eosinophils, may be caused by almost every condition that can cause pleural disease. Eosinophilic pleural effusion occurs most commonly during conditions associated with the presence of blood or air in the pleural space, infections, and malignancy. Drug-induced pleural effusions, pleural effusions accompanying pulmonary embolism, and benign asbestos pleural effusions are also among the common causes of eosinophilic pleural effusion. No etiology is found in as many as one third of patients. Because studies evaluating different diagnostic approaches with eosinophilic pleural effusions are lacking, the authors suggest that certain noninvasive and invasive diagnostic tools must be used based on the patient's clinical characteristics.
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Affiliation(s)
- Ioannis Kalomenidis
- Pulmonary Medicine Department, Saint Thomas Hospital and Vanderbilt University, Nashville, Tennessee, USA.
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ZILLE ALESSANDRAISABEL, PERIN CHRISTIANO, GEYER GERALDORESIN, HETZEL JORGELIMA, RUBIN ADALBERTOSPERB. Pneumonia eosinofílica crônica. ACTA ACUST UNITED AC 2002. [DOI: 10.1590/s0102-35862002000500007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pneumonia eosinofílica crônica é uma entidade clínica rara que se caracteriza por infiltração alveolar e intersticial eosinofílica, de causa desconhecida. Os autores descrevem o caso de uma mulher branca de 49 anos, admitida por dispnéia aos mínimos esforços, de início insidioso e progressivo havia seis meses. Apresentava eosinofilia sérica e no escarro, radiografias de tórax com áreas de infiltração multifocais de distribuição irregular em ambos os pulmões e, na avaliação funcional pulmonar, distúrbio restritivo. O exame histopatológico de tecido pulmonar obtido por biópsia a céu aberto evidenciou pneumonia eosinofílica crônica. Houve marcada melhora clínica, radiológica e funcional após corticoterapia.
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