Tuesday, 7 December 2010
- 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.
- 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 1st.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.
- 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.
- Clinicians should consider pulmonary eosinophilia in the differential diagnosis of patients treated for asthma who develop pulmonary infiltrates with dyspnea.