Chronic Eosinophilic Pneumonia

Today, Dr. Oldham presented an interesting case of an older man with a history of colon cancer s/p resection and 12 cycles of FOLFOX who presented with subacute fevers, non-productive cough, and DOE, found to have hypoxia, crackles on exam, peripheral eosinophilia, and peripheral lung consolidations, ultimately diagnosed with chronic eosinophilic pneumonia thought to be secondary to his oxaliplatin therapy.

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Learning Points:

1) Think about CEP when a patient has subacute to chronic respiratory symptoms, elevated blood and/or alveolar eosinophils, and peripheral pulmonary infiltrates on imaging.

2) There are multiple causes of pulmonary eosinophilia including:

  • Helminthic and fungal infections
  • Drug- and toxin-induced eosinophilic lung diseases (nitrofurantoin, minocycline, sulfonamides, ampicillin, daptomycin, phenytoin, L-tryptophan, plus many others)
  • Idiopathic acute eosinophilic pneumonia
  • Chronic eosinophilic pneumonia
  • Eosinophilic granulomatosis with polyangiitis

3) Treatment of CEP is glucocorticoids, often prednisone 0.5 mg/kg/day initially with a long taper over several weeks.