Chronic eosinophilic pneumonia in patient with difficult-to-treat asthma

Introduction

• Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare disorder of unknown cause characterised by subacute or chronic respiratory and general symptoms, alveolar and /or blood eosinophilia, and peripheral pulmonary infiltrates on chest imaging .
• Interestingly, some but not all patients diagnosed with ICEP have a history of asthma, whilst others may develop asthma after a dignosis of  ICEP has been made.

Case presentation

• An 66-year-old woman  with a history of asthma  and chronic rhinitis with polyps , nonsmoker, history of allergies negative, formerly farming work..
• She received antiasthmatic treatment with salmeterol/fluticasone propionate (50/500) bid since 2005, no other drugs. She suffered from frequent exacerbations of asthma .On 1^st.of September 2006 she had sudden fever, weight loss, malaise and impaired dyspnea with productive cough, mild chest pain on sternum and respiratory failure.  A chest radiograph demonstrated bibasilar infiltrates.

 

• Peripheral blood smear showed a newly developed, marked eosinophilia (20%), and a chest X-rays and  HRCT scan revealed a diffuse patchy nodular infiltrate in all lung fields.

Discussion

• We present this case, because ICEP is a rare complication of asthma, although it is seldom mentioned in reviews ant textbooks on asthma.  Asthma in patients with ICEP is relatively severe and get worse after diagnosis of ICEP . 
• The presence of asthma at the time of diagnosis of ICEP, is associated with less relapses of ICEP, possibly because of a higher frequency of long-term inhaled corticosteroids use in asthmatics .
• In our case no clinical relevant relaps of ICEP has occurred during 4-year follow-up.

 Conclusion

• Clinicians should consider pulmonary eosinophilia in the differential diagnosis of patients treated for asthma who develop pulmonary infiltrates with dyspnea.