Acute respiratory failure secondary to eosinophilic pneumonia following influenza vaccination in an elderly man with chronic obstructive pulmonary disease

Abstract

Acute respiratory failure with diffuse pulmonary opacities is an unusual manifestation following influenza vaccination. We report herein a patient with chronic obstructive pulmonary disease who developed fever with worsening of respiratory symptoms and severe hypoxemia requiring ventilatory support shortly after influenza vaccination. Bronchoalveolar lavage was compatible with acute eosinophilic pneumonia. Rapid clinical improvement was observed 2 weeks after systemic corticosteroid treatment, followed by radiographic improvement at 4 weeks. No disease recurrence was observed at the 6-month follow-up.

Keywords: Acute respiratory failure; Diffuse lung disease; Eosinophilic pneumonia; Influenza vaccination.

Figure 1

(A) Initial chest radiograph obtained 6 days after the influenza vaccine was administered, showing multi-focal areas of patchy and peribronchial opacities in both lungs. (B) Chest CT obtained 9 days after the influenza vaccine was administered, revealing a large area of ground-glass opacities with superimposed interlobular septal thickening, the so-called crazy-paving appearance (arrow), in the right upper lobe. (C) Chest CT at the level of the lower lungs, showing multi-focal areas of airspace consolidation in both lungs, with small amounts of bilateral pleural effusion.