Acute Eosinophilic Pneumonia. Causes, Diagnosis, and Management

Acute eosinophilic pneumonia (AEP) is an uncommon acute respiratory illness of varying severity that includes presentation as acute respiratory distress syndrome with fatal outcome. AEP may be idiopathic, but identifiable causes include smoking and other inhalational exposures, medications, and infe...

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Bibliographic Details
Published in:American journal of respiratory and critical care medicine 2018-03, Vol.197 (6), p.728-736
Main Authors: De Giacomi, Federica, Vassallo, Robert, Yi, Eunhee S, Ryu, Jay H
Format: Article
Language:English
Subjects:
Acute Disease
Asthma
Etiology
Humans
Hypoxemia
Illnesses
Influenza
Literature reviews
Lung diseases
Medical diagnosis
Pneumonia
Pulmonary Eosinophilia - diagnosis
Pulmonary Eosinophilia - physiopathology
Pulmonary Eosinophilia - therapy
Respiratory diseases
Respiratory failure
Respiratory therapy
Smoking
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Summary:Acute eosinophilic pneumonia (AEP) is an uncommon acute respiratory illness of varying severity that includes presentation as acute respiratory distress syndrome with fatal outcome. AEP may be idiopathic, but identifiable causes include smoking and other inhalational exposures, medications, and infections. The pathogenesis of AEP is poorly understood but likely varies depending on the underlying cause. Airway epithelial injury, endothelial injury, and release of IL-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 BAL 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 AEP, it may be absent or delayed, especially in smoking-related AEP. Optimal management of AEP 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 AEP of noninfectious origin. If AEP is recognized and treated in a timely manner, the prognosis is generally excellent, with prompt and complete clinical recovery, even in those patients manifesting acute respiratory failure.
ISSN:1073-449X
1535-4970
DOI:10.1164/rccm.201710-1967CI