Eosinophilic pulmonary infiltration

Hemolytic anemia Thrombocytopenia Neutropenia Aplastic anemia Eosinophilia Eosinophilic pulmonary infiltrates... 

The Stevens-Johnson syndrome after application of sulfonamide eye drops has been described several times after (Gottschalk and Stone 1976). Mackie and Mackbe (1979) report a case of systemic lupus erythematosus and dermatomyositis induced by sulfacetamide eye drops. Klinghoffer (1954) and Donlan and ScuTERO (1975) each observed one case of eosinophilic pulmonary infiltration after application of a vaginal cream containing sulfonamide. 

Eosinophilic pneumonia Pulmonary infiltrates with eosinophilia. If this occurs during the course of therapy, discontinue the drug. 

Bell RJ. Pulmonary infiltration with eosinophils caused by chlorpropamide. Lancet 1964 42 1249-50. 

ABPA is regarded as a complication of asthma, and occurs in approximately 1% of asthmatic patients. In addition to fever and malaise, the acute phase presents as an acute, easily reversible asthmatic syndrome with dyspnea and transient pulmonary infiltrations of eosinophils, neutrophils and lymphocytes, which may be effectively treated with corticosteroids. This condition usually progresses to a corticosteroid dependent and more intractable asthmatic state with transient pulmonary infiltrates (pulmonary eosinophilia) and a high sensitization to Aspergillus. From there the usual progression of the disease is to fibrosis and bronchiectasis. Most patients come to medical attention before the age of 35 years. The disease is a common complication of cystic fibrosis. 

O Hearn DJ, Leiferman KM, Askin F, Georas SN. Pulmonary infiltrates after cytokine therapy for stem cell transplantation. Massive deposition of eosinophil major basic protein detected by immunohistochemistry. Am J Respir Grit Care Med 1999 160(4) 1361-5. 

Immunological reactions to cromoglicate can involve the pericardium, the lung, the eye, the nasal mucosa, the skin, the joints, and the liver. Rarely, a hypersensitivity reaction can cause fever (4). A survey of the world literature up to 1982 found 13 cases of facial rash, urticaria, and/or generalized dermatitis, and one of nasal congestion. In 19 patients there was bronchospasm and/or pulmonary edema, eventually culminating in shock. Four cases of eosinophilic or granulomatous pulmonary infiltration, one of liver disease and vasculitis, one of pericarditis, and three of polymyositis were reported. 

A 46-year-old man with asthma was treated with oral roxithromycin 300 mg/day for 5 days for purulent rhinitis and 2 weeks later developed arthritis, mononeuritis multiplex, eosinophilia (64%), eosinophilic infiltrations in the bone marrow, raised IgE concentrations, and transient pulmonary infiltrates. Churg-Strauss sjmdrome was diagnosed. 

A 26-year-old asthmatic woman had severe acute necrotizing eosinophilic endomyocarditis while taking pranlukast, inhaled beclomethasone, and oral theophylline (4). Oral prednisolone had been replaced by pranlukast 9 months before the event. Cardiac injury was accompanied by peripheral eosinophilia, cardiogenic shock, and pulmonary infiltrates, suggesting atypical Churg-Strauss syndrome. She recovered after intensive treatment, steroid pulse therapy, and withdrawal of pranlukast. 

Dyspnea and pleurisy have been described. Of 52 travellers with adverse reactions to Fansidar in Sweden, six had pulmonary infiltrates accompanied by fever (SEDA-13, 241). Such infiltrates have also been described in the past, and in one case a diagnosis of eosinophilic infiltration was made (SEDA-11, 590). A case of non-cardiogenic pulmonary edema was reported in 1989 (SEDA-13, 813). 

Pulmonary infiltrates with eosinophilia (Loeffler s syndrome) have been associated with nitrofurantoin,para-aminosalicytic acid, methotrexate, sulfonamides, tetracycline, chlorpropamide, phenytoin, NSAIDs, and imipramine (Table 29-5). The disorder is characterized by fever, nonproductive cough, dyspnea, cyanosis, bilateral pulmonary infiltrates, and eosinophilia in the blood. Lung biopsy has revealed perivasculitis with infiltration of eosinophils, macrophages, and proteinaceous edema fluid in the alveoli. The symptoms and eosinophilia generally respond rapidly to withdrawal of the offending drug. 

In acute eosinophilic pulmonary reactions after nitrofurantoin there is an interval between application of the drug and appearance of the reaction. A peripheral eosinophilia is shown. Histologically it is a matter of eosinophilic infiltration with edema and perivasculitis in the lungs. Observations supporting an allergic genesis are ... 

Corticosteroids are the current standard treatment of OP (2,6,9,11,16-19), although spontaneous improvement has occasionally been reported (2). Clinical improvement is usually observed within two days after treatment onset. At imaging, pulmonary infiltrates usually markedly improve within a few days and disappear completely within a few weeks. The speed of response to corticosteroids in OP is slower than in chronic idiopathic eosinophilic pneumonia, but faster than in NSIP and roughly comparable to hypersensitivity pneumonitis. The spectacular and reproducible response to corticosteroids can further be considered as an additional diagnostic feature of the clinical syndrome of OP, and if this response is poor, the initial diagnosis should be reconsidered. Removal of the causing agent should be done in secondary OP, whenever possible. 

Blood eosinophilia > 10% Mononeuropathy (including multiplex) or pol3meuropathy Nonfixed pulmonary infiltrates on roentgenography Paranasal sinus abnormality Biopsy containing a blood vessel with extravascular eosinophils... 

Lukacs, N.W., Strieter, RM., Chensue, S.W. and Kunkel, S.L. Interleukin-4-dependent pulmonary eosinophil infiltration in a murine model of asthma. Am. J. Respir. Cell Mol. Biol. 10, 526-530. 

Various studies have also examined animal models of pulmonary inflammation that are representative of primary eosinophil or neutrophil infiltration. Lung inflammation characterized by eosinophil influx has been used as a model of asthma and is not generally associated with lung fibrosis. After several episodes of repeated antigen challange, a subset of Ascaris -sensitive Cynomolgus monkeys developed a persistent eosinophilia and enhanced intercellular adhesion molecule-1 (ICAM-1) expression on pulmonary endothelial and epithelial cells when compared to control animals (Gundel etal., 1991, 1992). 

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