Eosinophilic pneumonia and/or eosinophilic asthma – clinical case

Abstract

Eosinophilic pneumonias are a heterogeneous group of lung diseases characterized by eosinophilic infiltrates of the respiratory tracts, alveoli or interstitium. They can be primary (idiopathic), secondary (drug-induced, as a result of taking toxic substances, in some parasitosis, etc.), acute or chronic. The differentiation of eosinophilic pneumonia in patients with underlying bronchial asthma requires a complex diagnostic approach, as well as a correct interpretation of clinical and laboratory information. Clinical case: It concerns a man with underlying pulmonary disease (COPD and bronchiectasis disease), followed by a pulmonologist on an outpatient basis, hospitalized due to dyspnea, cough with expectoration, sweating, chills and easy fatigue. Laboratory tests revealed peripheral eosinophilia (830 cells mm3) and high serum IgE values (740.2 [IU]/mL) and a positive BDT was recorded. The diagnosis of COPD was ruled out hospitalized due to exacerbation and evidence of apical infiltrative opacities on radiography and CT scan. Again, high values of IgE (1150 [IU]/mL) and Eo (1750 cells mm3) were recorded, as well as lowest values of FEO1 (0.83 L/36.84%) during an attack. Due to suspicion of eosinophilic pneumonia, bronchoscopy with bronchoalveolar lavage were performed, which confirmed the diagnosis. A course of systemic corticosteroids was started for 1 month. 4 months later, the patient was again admitted to the department with clinical data of exacerbation of bronchial asthma on the background of high FEO1 values (2.20 l/98.44%), high Eo count (530 cells mm3) and IgE up to 843.1 [IU]/mL, as well as complete reduction of the described X-ray and CT changes. The patient was discussed for initiation of biologic therapy for severe asthma aimed at reducing eosinophils. Discussion: The described clinical case raises questions about the presence of severe asthma with normal spirometric parameters, the relationship between bronchial asthma and eosinophilic pneumonia, and potential co-treatment with biological therapy aimed at reducing eosinophils.