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Acute Eosinophilic Pneumonia in a New York City Firefighter Exposed to World Trade Center Dust

Division of Pulmonary and Critical Care Medicine, Departments of Medicine, Environmental Medicine, Radiology and Pathology, New York University School of Medicine, New York; Division of Pulmonary Medicine, Albert Einstein College of Medicine, Bronx; New York City Fire Department, Bureau of Health Services, New York, New York; and Department of Pathology, Duke University Medical Center, Durham, North Carolina

Correspondence and requests for reprints should be addressed to William N. Rom, M.D., M.P.H., Division of Pulmonary and Critical Care Medicine, Departments of Medicine, Environmental Medicine, Radiology and Pathology, New York University School of Medicine, 530 1st Ave., New York, NY 10016. E-mail: william.rom{at}med.nyu.edu

We report a sentinel case of acute eosinophilic pneumonia in a firefighter exposed to high concentrations of World Trade Center dust during the rescue effort from September 11 to 24. The firefighter presented with a Pa_O2 of 53 mm Hg and responded to oxygen and corticosteroids. Computed tomography scan showed patchy ground glass density, thickened bronchial walls, and bilateral pleural effusions. Bronchoalveolar lavage recovered 70% eosinophils, with only 1% eosinophils in peripheral blood. Eosinophils were not degranulated and increased levels of interleukin-5 were measured in bronchoalveolar lavage and serum. Mineralogic analysis counted 305 commercial asbestos fibers/10⁶ macrophages including those with high aspect ratios, and significant quantities of fly ash and degraded fibrous glass. Acute eosinophilic pneumonia is a rare consequence of acute high dust exposure. World Trade Center dust consists of large particle–size silicates, but fly ash and asbestos fibers may be found in bronchoalveolar lavage cells.

Key Words: asbestos • eosinophil • firefighter

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