Pulmonary infiltrates with eosinophilia

Drugs That Induce Pulmonary Infiltrates with Eosinophilia (Loeffler s Syndrome)... 

Pulmonary infiltrates Pulmonary infiltrates with eosinophilia may occur with beclomethasone or flunisolide. 

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

Hypersensitivity Anaphylactoid purpura, anaphylaxis, angioneurotic edema, myocarditis, pericarditis, polyarthralgia, pulmonary infiltrates with eosinophilia, systemic lupus erythematous exacerbation, urticaria hypersensitivity syndrome (cutaneous reaction, eosinophilia, and one or more of the following Hepatitis, pneumonitis, nephritis, myocarditis, pericarditis, fever, lymphadenopathy). Muscuioskeietai - ArVr ra g a, arthritis, bone discoloration, joint stiffness and swelling, myalgia, polyarthralgia. 

Bascom et al. (1988) reported a spectrum of respiratory illnesses which occurred in a group of workers who were exposed to heated chloroprene-based rubber. These included an acute sensitizing illness with dyspnoea and wheezing in some workers and pulmonary infiltrates with eosinophilia in others. One worker developed chronic obstruc-tion of the airways with recurrent bronchitic illnesses. 

Pulmonary infiltrates with eosinophilia have been described with ibuprofen (SEDA-18,104). 

A syndrome of pulmonary infiltration with eosinophilia occurred in an 83-year-old man who was given pipera-cilhn plus tosufloxacin (3). 

Cases of allergic pneumonitis and pulmonary infiltrates with eosinophilia have been described with co-trimoxa-zole (23). Such reactions have not been reported with trimethoprim alone. Pulmonary infiltrates due to co-tri-moxazole hypersensitivity in patients with AIDS are particularly worrisome, since they mimic progression of underlying opportunistic pulmonary infections. 

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. 

Among pulmonary manifestations of drug allergy, therapeutic or professional (factory workers) inhalation of penicillins may lead to asthma (Rudzki et al. 1966 Davies et al. 1974), while the occurrence of pulmonary infiltrates with eosinophilia has also been reported (Reichlin et al. 1953). 

Israel and Diamond (1962) were the first to report after nitrofurantoin a case of recurrent pulmonary infiltration with eosinophilia and pleural exudate taking the course of pulmonary embolism. 

Tseng OL, Kelsall JT, Wilcox PG. Pipera-dllin-associated pulmonary infiltrates with eosinophilia a case report. Can Respir J 2010 17(2) e24-6. 

Various antibiotics, in particular sulfonamides, beta-lactam compounds, tetracycline and ethambutol, may induce pulmonary toxicities, which usually consist of pulmonary infiltrates with eosinophilia. Dmg-induced lupus states have also been reported with minocychne and tetracycline, nalidixic acid, sulfonamides, and nitrofurantoin (1). 

Of these agents, zileuton is the least prescribed because of reports of occasional liver toxicity. The receptor antagonists appear to have little toxicity. Reports of Churg-Strauss syndrome (a systemic vasculitis accompanied by worsening asthma, pulmonary infiltrates, and eosinophilia) appear to have been coincidental, with the syndrome unmasked by the reduction in prednisone dosage made possible by the addition of zafirlukast or montelukast. Of these two, montelukast is the most prescribed, probably because it can be taken without regard to meals and because of the convenience of once-daily treatment. 

Two episodes of acute pulmonary edema and progressive pulmonary infiltrates without eosinophilia have been reported in a man with HIV infection after ibuprofen (SEDA-18,104). 

Wang KK, Bowyer BA, Fleming CR, Schroeder KW. Pulmonary infiltrates and eosinophilia associated with sulfasalazine. Mayo Clin Proc 1984 59(5) 343-6. 

NSAIDs also have been associated with pulmonary infiltrates and eosinophilia (PIE) syndrome. This syndrome is associated with fever, cough, dyspnea, infiltrates on chest roentgenogram, and a peripheral eosinophilia that develop 2 to 6 weeks after initiating treatment. PIE syndrome occurs more frequently for naproxen compared with other NSAIDs and is noted to resolve rapidly after discontinuation of the offending agent. ... 

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. 

Two cases of alveolitis have been reported with captopril, one associated with eosinophilia (1) and the other with a lymphocytic pulmonary infiltrate (2). 

Wechsler ME, Garpestad E, Flier SR, Kocher O, Weiland DA, Polito AJ, Khnek MM, Bigby TD, Wong G A, Helmers R A, Drazen JM. Pulmonary infiltrates, eosinophilia, and cardiomyopathy following corticosteroid withdrawal in patients with asthma receiving zafirlukast. JAMA 1998 279(6) 455-7. 

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. 

Fever occurs in about a quarter of patients taking oxamniquine (SEDA-11, 598) (7), and in some 15% of these, a Lbffler-like syndrome with eosinophilia and pulmonary infiltrates was seen when it was specifically looked for. 

D. Oxamniquine Oxamniquine is effective solely in Schistosoma mansoni infections, acting on male immature forms and adult schistosomal forms. Dizziness is a common adverse effect headache, gastrointestinal irritation, and pruritus may also occur. Reactions to dying parasites include eosinophilia, urticaria, and pulmonary infiltrates. It is not advisable to use the drug in pregnancy or in patients with a past history of seizure disorders. 

Eosinophilia was not observed. In one patient pulmonary fibrosis was seen, in another pulmonary infiltrates. In one patient with chronic active hepatitis a specific lymphocytic transformation was observed within 3 months after the beginning of therapy with nitrofurantoin, in another patient the authors observed immune complexes of polyclonal IgG antibodies and autologous albumin. Some patients, all women, had HLA B 8. 

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 ... 

Respiratory A 54-year-old woman developed pulmonary infiltrates associated with fever, chills, shortness of breath, intermittent chest pains, and an eosinophilia after taking piperacillin-I-tazobactam for 4 days [53 ]. 

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

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