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Idiopathic Acute Eosinophilic Pneumonia

A Study of 22 Patients

Service d'Assistance Respiratoire et Réanimation Médicale, Hôpital de la Croix Rousse; Service de Pneumologie, Hôpital Louis Pradel, Lyon; and Service de Pneumologie, Hôpital Tenon, Paris, France

Correspondence and requests for reprints should be addressed to Prof. Jean-François Cordier, GERM"O"P, Hôpital Louis Pradel, BP Lyon-Montchat 69394, Lyon cedex 03, France. E-mail: germop{at}univ-lyon1.fr

Idiopathic acute eosinophilic pneumonia (IAEP) is characterized by acute febrile respiratory failure associated with diffuse radiographic infiltrates and pulmonary eosinophilia. We conducted a multicenter retrospective study to characterize this rare clinical entity further and to improve its diagnostic criteria. A total of 13 male and 9 female patients (mean age: 29 ± 15.8 years) presented with severe hypoxemia (Pa_O2/fraction of inspired oxygen ratio = 156 ± 74.1) requiring mechanical ventilation in 14 cases. Bronchoalveolar lavage was performed on all patients and showed 54.4 ± 19.2% eosinophils on differential cell count, but no open-lung biopsies were done. No clinical differences were found between patients seen at less than 7 days (n = 15) or at 7 to 31 days (n = 7) from the onset of IAEP. A total of 12 patients met the clinical criteria of acute lung injury, and eight of these patients met the criteria for acute respiratory distress syndrome. All patients recovered, either spontaneously (6) or on corticosteroid treatment (16). No relapses occurred. We conclude that: (1) diagnostic criteria of IAEP are compatible with a duration of symptoms for up to 1 month, but the response to corticosteroid treatment is not diagnostic because of possible spontaneous recovery; (2) IAEP should be considered as differential diagnosis of acute lung injury or acute respiratory distress syndrome; (3) bronchoalveolar lavage eosinophilia obviates the need for lung biopsy in IAEP.

Key Words: pulmonary eosinophilia • bronchoalveolar lavage • respiratory distress syndrome, adult

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