Smoking-Induced Acute Eosinophilic Pneumonia in a 15-year-old Girl: A Case Report

Abstract

Acute eosinophilic pneumonia is a very rare disease that is characterized by acute febrile respiratory failure, diffuse bilateral infiltrates on chest X-ray, and eosinophilia in bronchoalveolar lavage fluid in the absence of infection. We present the case of a 15-year-old girl diagnosed with smoking-induced acute eosinophilic pneumonia. A previously healthy young girl with a 1-day history of fever presented with cough, dyspnea, and diffuse bilateral infiltrates on chest X-ray. She had started smoking only 3 weeks before presentation. She was diagnosed by bronchoalveolar lavage fluid tests and lung biopsy and dramatically improved after steroid treatment. We emphasize that acute eosinophilic pneumonia must be considered when acute pneumonia does not respond to broad-spectrum antibiotics. Effective treatment and prompt institution of therapy can obviate unnecessary morbidity and mortality.

Keywords: Pulmonary eosinophilia; adolescent; bronchoalveolar lavage fluid; smoking.

Fig. 1

Serial chest X-ray on admission, hospital days 5, 6 and 7 showing dramatic improvement after the initiation of corticosteroids on hospital day 5.

Fig. 2

Chest CT on admission (A) and follow-up after 2 months (B) reveals markedly improved ground glass opacity and air space consolidation in both lungs.

Fig. 3

(A) Bronchoalveolar lavage fluid showed more than 25% eosinophils. (Wright stain, ×400). (B) Lung biopsy specimen on the third day shows that many inflammatory cells are present in the alveolar spaces and septae, which are admixed with fibrous exudates. The majority of the infiltrated cells are eosinophils (Hematoxylin-eosin stain, ×400).