Acute eosinophilic pneumonia accompanied with COVID-19: a case report

Abstract

We report a case of acute eosinophilic pneumonia (AEP) triggered by coronavirus disease 2019 (COVID-19) infection. A 77-year-old man experienced left-sided chest pain and shortness of breath. Reverse transcription-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) revealed a positive result, and he was treated with favipiravir, ciclesonide, and lascufloxacin, but he showed poor improvement. On the other hand, computed tomography (CT) images were atypical for COVID-19 infection, and the elevation of eosinophil was found in blood and the fluid obtained by bronchoscopy. So, we clinically diagnosed this case as AEP. Administration of prednisolone dramatically improved the patient's clinical condition and chest radiograph findings, which were consistent with the clinical course of AEP. This case suggests the importance of considering the complications of AEP when treating patients with COVID-19 infection.

Keywords: Acute eosinophilic pneumonia; COVID‐19; SARS‐CoV‐2.

Figure 1

Serial chest computed tomography (CT) images of the patient on (A) hospital day 1, (B) hospital day 11, (C) hospital day 21, and (D) hospital day 46, and the elevation of eosinophil in the lung. (A, B) Bilateral upper and middle areas of ground‐glass opacities and consolidations at the subpleural and peribronchial regions. (C) Pleural effusions were observed in the left side. (D) Post‐treatment with prednisolone (PSL). (E) The fluid obtained by bronchoscopy were cytospun onto glass slides and stained with Giemsa's staining solution. Representative image is shown. Bold scale bar, 20 μm.

Figure 2

Clinical course of the patient. The number of eosinophils gradually increased for the initial 21 days. After the start of prednisolone (PSL) administration, the number of white blood cells and eosinophils promptly decreased.