02. tbl 93. árg. 2007

Fræðigrein

Chronic eosinophilic pneumonia in Iceland: Clinical features, epidemiology and review

Langvinn eósínófíl lungnabólga á Íslandi Faraldsfræði, klínísk einkenni og yfirlit

Læknablaðið 2007; 93: 109-14

Objective: The objective of the study was to describe the incidence and clinical features of chronic eosinophilic pneumonia (CEP) in Iceland and review recent literature.

Material and methods: Retrospective study where information was obtained from clinical charts from 1990-2004. Records, imaging studies and histopathology were evaluated.

Results: During the study period 10 individuals were diagnosed with CEP, 7 males and 3 females. Mean age was 58 years. None of the patients was a current smoker. The incidence of CEP during the study period was 0.23 per 100.000/year but increased to 0.54 per 100.000/year during the last 5 years of the study period. Clinical symptoms were malaise, cough, dyspnea, sweating and weight loss. Sedimentation rate was 72 mm/h and C-reactive protein (CRP) 125 mg/L. Eight of the ten patients had increase in blood eosinophils. On chest auscultation crackles were heard in seven patients and wheezing in three. Forced vital capacity (FVC) was 75% of predicted value and forced expiratory volume in one second (FEV1) was 73% of predicted. Mean PO2 was 68 mmHg. All the patients had classic diffuse bilateral opacities on chest radiograph that most commonly were peripheral. All patients were treated with corticosteroids and responded well. The average initial dose of Prednisolone was 42.5 mg per day. Seven of the patients relapsed but they all responded well to repeated treatment.

Conclusions: Chronic eosinophilic pneumonia is a rare disorder but it has specific radiologic and histologic features. It is important to think of the disease in patients with diffuse infiltrates that are resistant to antibiotics. CEP responds well to corticosteroids but there is a high relapse rate, which also responds to treatment.

 

Figure 1. Chest radiograph from a patient with chronic eosinophilic pneumonia with typical bilateral peripheral infiltrates.

Figure 2.  Transbronchial biopsy showing alveoli filled with eosinophils and variable numbers of macrophages. Also noted is mild chronic interstitial inflammation (H&E, x 25).

Figure 3. Transbronchial biopsy. Alveoli filled with eosinophils admixed with some macrophages (H&E, x 40).

 


 

Table 1. Clinical features in patients with chronic eosinophilic pneumonia.

Patient

Sex

Age at diagnosis

Symptoms and signs

Asthma

Smoking

status

Chest auscultation

Laboratory values: ESR mm/hr, CRP mg/L

Initial

Treatment

Prednisolon

Relapse

1

Male

68 years

Malaise, fever, sweat, dyspnea and cough.

No

Former

Crackles

ESR, 64, CRP 101. Eos. normal.

30 mg

No

2

Female

62 years

Malaise, cough, fever.

Yes

Former

Crackles

ESR 23, CRP 26.

Eos. 32%.

60 mg

Yes

3

Female

36 years

Malaise, cough, sweat, fever, weight loss and dyspnea.

No

Never

Crackles

ESR 94, CRP 426.

Eos. 25%.

40 mg

No

4

Male

77 years

Malaise, cough, fever, and sweat.

Yes

Never

Rhonchi

ESR 58, CRP 41.

Eos. 45%

40 mg

Yes

5

Male

60 years

Malaise, cough, dyspnea, weight loss, sweat and fever.

Yes

Former

Crackles

ESR 40.

Eos. 27%.

50 mg

Yes

6

Male

52 years

Malaise, fever, cough, sweat and weight loss.

Yes

Former

Rhonchi

ESR 67, CRP 54.

Eos. 50%.

40 mg

Yes

7

Female

24 years

Malaise, fever, cough.

Yes

Former

Crackles

ESR 124.

Eos. 14%.

60 mg

Yes

8

Male

71 years

Malaise, fever, cough, sweat and weight loss.

Yes

Former

Crackles/ rhonchi

ESR 110. CRP 250. Eos. normal.

40 mg

Yes

9

Male

50 years

Malaise, dyspnea, fever and cough.

No

Former

Crackles

ESR 22, CRP 31.

Eos. 18%

40 mg

Yes

10

Male

76 years

Malaise, dyspnea, fever and cough.

No

Never

Normal

ESR 116.

Eos. 9%.

40 mg

No



 

 



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