Acute Eosinophilic Pneumonia Complicated with Venous Thromboembolic Disease-Diagnostic and Therapeutic Considerations

Abstract

Acute Eosinophilic Pneumonia (AEP) is a rare idiopathic disease caused by an accumulation of eosinophils in the pulmonary alveoli and interstitial tissue of the lungs. The onset of symptoms is acute; some patients develop respiratory failure. The diagnosis is based on clinical symptoms, diffuse interstitial infiltrates in the lungs on imaging studies, and eosinophilia exceeding 25% on bronchoalveolar lavage or pleural fluid smear. Smokers are primarily at increased risk for the disease. We present a case of venous thromboembolic disease (VTE) that developed in the course of AEP in a previously healthy male smoker. Complete remission of the disease was achieved with anticoagulation therapy combined with a low dose of steroids. Surprisingly, further diagnostics revealed the presence of thrombophilia: antithrombin (AT) deficiency and increased homocysteine level. According to our knowledge, this is the first case of VTE diagnosed in the course of AEP combined with thrombophilia.

Keywords: acute eosinophilic pneumonia; antithrombin deficiency; pulmonary embolism; thrombophilia; venous thrombosis.

Figure 1

Postero-anterior chest X-ray showing bilateral interstitial infiltrates (white arrows) and left-sided pleural effusion (black arrow).

Figure 2

Computed tomography pulmonary angiography (CTPA) scan showing massive right pulmonary artery embolism (white arrows) (a), high resolution computed tomography (HRCT) of the chest showing ground glass opacities in the right upper lobe (white arrow), and left-sided pleural effusion (black arrow) (b).

Figure 3

Postero-anterior chest X-ray showing complete regression of interstitial infiltrates and pleural effusion.

Figure 4

Computed tomography pulmonary angiography (CTPA) scan showing complete resolution of right pulmonary artery embolism (arrows) (a), high resolution computed tomography (HRCT) of the chest showing resolution of ground glass opacities in the right upper lobe) black arrow) and left-sided pleural effusion (white arrow) (b).