A Case of 16-Year-Old Boy with Smoking-Induced Acute Eosinophilic Pneumonia

Acute eosinophilic pneumonia (AEP) is a rare disease characterized by acute febrile respiratory insufficiency, marked eosinophilia in bronchoalveolar lavage fluid (BALF), diffuse bilateral and thickening of interlobular septa on chest radiographic findings. Pathogenesis is not well understood, however direct or indirect exposure to smoke has been repeatedly reported as a cause of AEP. We present a case of 16-year-old boy, who developed an idiopathic AEP with no peripheral eosinophilia, marked eosinophilia in BALF (36.6%), decreased DLco (75%), typical radiologic findings, and dramatically improved after corticosteroid treatment without use of antibiotics. Despite best efforts, no evidence of infection was found. Although he initially denied a current smoking, we repeatedly asked the previous history of smoking cigarettes. He finally told the truth that he had started to smoke 19 days before hospitalization in an enclosed area with friends, and gradually increased smoking-dose. Conclusively, we suggest that no peripheral eosinophilia does not exclude an AEP, and clinical suspicion with exact history taking and radiologic findings, and early BALF exam will be the best approach to avoid use of unnecessary antibiotics and for the proper management.