Acute Eosinophilic Pneumonia: Causes, Diagnosis and Management.

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Acute Eosinophilic Pneumonia: Causes, Diagnosis and Management.

Am J Respir Crit Care Med. 2017 Dec 05;:

Authors: De Giacomi F, Vassallo R, Yi ES, Ryu JH

Abstract
Acute eosinophilic pneumonia is an uncommon acute respiratory illness of varying severity that includes presentation as acute respiratory distress syndrome with fatal outcome. Acute eosinophilic pneumonia may be idiopathic but identifiable causes include smoking and other inhalational exposures, medications and infections. The pathogenesis of acute eosinophilic pneumonia is poorly understood but likely varies depending on the underlying cause. Airway epithelial injury, endothelial injury and release of interleukin-33 are early events that subsequently promote eosinophil recruitment to the lung; eosinophilic infiltration and degranulation appear to mediate subsequent lung inflammation and associated clinical manifestations. Crucial for the diagnosis are the demonstration of pulmonary eosinophilia in the bronchoalveolar lavage fluid and the exclusion of other disease processes that can present with acute pulmonary infiltrates. Although peripheral blood eosinophilia at initial presentation may be a clue in suggesting the diagnosis of acute eosinophilic pneumonia, it may be absent or delayed, especially in smoking-related acute eosinophilic pneumonia. Optimal management of acute eosinophilic pneumonia depends on the recognition and elimination of the underlying cause when identifiable. The cessation of the exposure to the inciting agent, e.g., smoking, and glucocorticoids represent the mainstay of treating acute eosinophilic pneumonia of non-infectious origin. If acute eosinophilic pneumonia is timely recognized and treated, the prognosis is generally excellent with prompt and complete clinical recovery, even in those patients manifesting acute respiratory failure.

PMID: 29206477 [PubMed - as supplied by publisher]

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