Eosinophilic Lung Disease: Accompanied with 12 Cases

Abstract

Objectives: Eosinophilic lung diseases are a rare group of heterogeneous diseases characterized by the increase of the eosinophil ratio in airways and lung parenchyma. In our clinic, patients diagnosed with eosinophilic lung disease were evaluated with their clinical features and prognoses.

Material and methods: In our clinic, 12 cases that were diagnosed and followed up for eosinophilic lung disease [eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome) (n=4), chronic eosinophilic pneumonia (CEP) (n=7), and simple pulmonary eosinophilia (Löffler's syndrome) (n=1)] were retrospectively evaluated.

Results: Of the 12 cases, 8 were females, and the average age was 43 (28-72) years. All cases were undergoing bronchodilator therapy with asthma diagnosis (2 months-40 years). Additionally, 4 of the cases had sinusitis, and 1 had allergic rhinitis. The most common complaints of the patients were difficulty in breathing and coughing, and the duration of complaints was a median of 2 months. Peripheral eosinophilia and total IgE elevation were present during the admission of all cases; additionally, leucocyte elevation was recorded in 10 of them, anemia in 4 of them, and thrombocytosis in 4 of them. Moreover, 43% of the recorded DLCO values were lower than normal. Of the 10 cases that underwent bronchoalveolar lavage (BAL), the eosinophil ratio was above 25% in 7 subjects. Of the 8 cases that underwent transbronchial biopsy, eosinophil-involving infiltration was detected in 6 subjects. Additional findings in cases diagnosed with EGPA were nasal polyposis (n=1), sinusitis (n=2), polyneuropathy (n=1), cardiac involvement (n=2), and skin involvement in biopsy (n=1). Spontaneous recovery was observed in the patient diagnosed with simple pulmonary eosinophilia during the follow-up that was performed based on the history and laboratory and BAL results of the patient. Prednisolone treatment was started for all cases, except for simple pulmonary eosinophilia, and their controls were performed. Relapse was observed in eight cases (EGPA: 4, CEP: 4); during the relapse treatment of one case diagnosed with EGPA, exitus occurred. One case rejected treatment despite the presence of peripheral eosinophilia, and the other cases are being followed-up without medication.

Conclusion: Given that the clinical pictures in pulmonary eosinophilia syndromes are on a wide spectrum, a specific diagnosis is important. Progression may differ in each patient, and a close follow-up is necessary during and after the treatment.

Keywords: Churg–Strauss syndrome; Löffler’s syndrome; chronic eosinophilic pneumonia; eosinophilic granulomatosis with polyangiitis.

Figure 1

Exitus EGPA case. (a) Thoracic CT performed at diagnosis. (b) Thoracic CT performed under corticosteroid therapy in the second month. (c) Recurrence 2 months after the discontinuation of corticosteroid therapy

Figure 2

EGPA cases, clinical findings and monitorization results EGPA: eosinophilic granulomatosis with polyangiitis; bx: biopsy; CS: corticosteroid; TBB: transbronchial biopsy

Figure 3

EGPA case with myocardial involvement. (a) Chest radiography performed at diagnosis. (b) Chest radiography performed at the end of the first month of corticosteroid therapy

Figure 4

Prognoses of chronic eosinophilic pneumonia cases CEP: chronic eosinophilic pneumonia; CS: corticosteroid

Figure 5

Chronic eosinophilic pneumonia case. (a) Chest radiography at diagnosis. (b) Thoracic CT at diagnosis. (c) Regression in the second week of corticosteroid therapy

Figure 6

Chronic eosinophilic pneumonia case. (a) PA chest radiography at diagnosis. (b) Regression in the first month of corticosteroid therapy

Figure 7

Simple pulmonary eosinophilia case. (a) Chest radiography at diagnosis. (b) Regression observed 1 month later